Healthcare Provider Details

I. General information

NPI: 1861385452
Provider Name (Legal Business Name): AUSTIN CARE STEPHENSON PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2025
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 BEAUMONT CENTRE CIR STE 100
LEXINGTON KY
40513-1959
US

IV. Provider business mailing address

205 CHARLES T WETHINGTON BUILDING
LEXINGTON KY
40536-0200
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-5544
  • Fax: 859-257-9286
Mailing address:
  • Phone: 859-257-5001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberTC090
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberTC090
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberTC090
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: