Healthcare Provider Details

I. General information

NPI: 1386078848
Provider Name (Legal Business Name): STACIE ANN CAIN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2013
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 TOWNE DR STE 104
ELIZABETHTOWN KY
42701-8460
US

IV. Provider business mailing address

PO BOX 776351
CHICAGO IL
60677-6351
US

V. Phone/Fax

Practice location:
  • Phone: 270-769-2273
  • Fax: 270-769-2244
Mailing address:
  • Phone: 502-588-9490
  • Fax: 502-272-5116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3008258
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: