Healthcare Provider Details

I. General information

NPI: 1942164546
Provider Name (Legal Business Name): HIDDEN VALLEY HEALTHCARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

174 CHALLENGER RD
GRAYSON KY
41143-1783
US

IV. Provider business mailing address

174 CHALLENGER RD
GRAYSON KY
41143-1783
US

V. Phone/Fax

Practice location:
  • Phone: 606-315-8515
  • Fax:
Mailing address:
  • Phone: 606-315-8515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: WHITNEY STIDHAM
Title or Position: CEO
Credential: APRN
Phone: 606-315-8515