Healthcare Provider Details

I. General information

NPI: 1124956321
Provider Name (Legal Business Name): CHRISTINA STEVENS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

256 ZOE DR
GLASGOW KY
42141-7976
US

IV. Provider business mailing address

256 ZOE DR
GLASGOW KY
42141-7976
US

V. Phone/Fax

Practice location:
  • Phone: 270-590-0676
  • Fax:
Mailing address:
  • Phone: 270-590-0676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1115683
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: