Healthcare Provider Details

I. General information

NPI: 1710983564
Provider Name (Legal Business Name): CASSANDRA STEPHENS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2005
Last Update Date: 08/03/2015
Certification Date:
Deactivation Date: 03/17/2006
Reactivation Date: 03/30/2006

III. Provider practice location address

70 UBERMONKEY LN
CAMPBELLSVILLE KY
42718-5217
US

IV. Provider business mailing address

70 UBERMONKEY LN
CAMPBELLSVILLE KY
42718-5217
US

V. Phone/Fax

Practice location:
  • Phone: 270-465-0060
  • Fax: 270-465-0134
Mailing address:
  • Phone: 270-465-0060
  • Fax: 270-465-0134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number31329
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: