Healthcare Provider Details

I. General information

NPI: 1124555222
Provider Name (Legal Business Name): FREDERICK ADOLPHUS STINE VI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2017
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 TURFWAY ROAD
FLORENCE KY
41042-1379
US

IV. Provider business mailing address

PO BOX 432
PIKEVILLE KY
41502-0432
US

V. Phone/Fax

Practice location:
  • Phone: 859-212-5025
  • Fax:
Mailing address:
  • Phone: 606-430-2230
  • Fax: 606-437-2526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34.017557
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2020-01884
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number04992
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: