Healthcare Provider Details

I. General information

NPI: 1376015602
Provider Name (Legal Business Name): STEFANIE KAYE SPALDING MSN, APRN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2018
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 N LORETTO RD
LEBANON KY
40033-1300
US

IV. Provider business mailing address

320 N LORETTO RD
LEBANON KY
40033-1300
US

V. Phone/Fax

Practice location:
  • Phone: 270-692-5187
  • Fax: 270-699-4621
Mailing address:
  • Phone: 270-692-5187
  • Fax: 270-699-4621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3012969
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number3012969
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: