Healthcare Provider Details

I. General information

NPI: 1912991969
Provider Name (Legal Business Name): KATHLEEN MARIE STEVENS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 10/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

289 IRELAND AVE. BUILDING 851
FORT KNOX KY
40121-5111
US

IV. Provider business mailing address

545 LEVI BEAMS RD
MAGNOLIA KY
42757-7960
US

V. Phone/Fax

Practice location:
  • Phone: 502-624-4031
  • Fax:
Mailing address:
  • Phone: 270-324-3085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2403P
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number2403M
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: