Healthcare Provider Details

I. General information

NPI: 1932196615
Provider Name (Legal Business Name): ANNE C STEVENSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 03/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 WOODLAND DR
ELIZABETHTOWN KY
42701-2709
US

IV. Provider business mailing address

PO BOX 950202
LOUISVILLE KY
40295-0202
US

V. Phone/Fax

Practice location:
  • Phone: 270-765-2107
  • Fax: 270-769-9642
Mailing address:
  • Phone: 502-969-6552
  • Fax: 502-969-3799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number39461
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: