Healthcare Provider Details

I. General information

NPI: 1689879405
Provider Name (Legal Business Name): STEPHEN B NOE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 01/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 BRYAN BLVD STE 201
CORBIN KY
40701-2788
US

IV. Provider business mailing address

PO BOX 950248
LOUISVILLE KY
40295-0248
US

V. Phone/Fax

Practice location:
  • Phone: 606-526-4590
  • Fax: 606-526-0548
Mailing address:
  • Phone: 502-489-5730
  • Fax: 502-489-5753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA788
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: