Healthcare Provider Details

I. General information

NPI: 1487308748
Provider Name (Legal Business Name): JENNA JANINE STEPHENS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2022
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE ST
LEXINGTON KY
40536-1067
US

IV. Provider business mailing address

800 ROSE ST
LEXINGTON KY
40536-7001
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-6047
  • Fax: 859-257-3873
Mailing address:
  • Phone: 304-231-4047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA3123
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: