Healthcare Provider Details

I. General information

NPI: 1568664142
Provider Name (Legal Business Name): TRACY LOUISE STEPHENS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 03/05/2021
Certification Date: 03/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 N GRAND AVE
FORT THOMAS KY
41075-1793
US

IV. Provider business mailing address

PO BOX 635283
CINCINNATI OH
45263-5483
US

V. Phone/Fax

Practice location:
  • Phone: 859-912-7211
  • Fax: 859-655-6674
Mailing address:
  • Phone: 859-344-5555
  • Fax: 859-344-5552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71004389A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3007746
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number291717
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: