Healthcare Provider Details

I. General information

NPI: 1639884778
Provider Name (Legal Business Name): TRUMELL STEVON IKARD APRN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2023
Last Update Date: 01/23/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1099 DUVAL ST STE 100
LEXINGTON KY
40515-6490
US

IV. Provider business mailing address

1073 DUVAL ST
LEXINGTON KY
40515-6283
US

V. Phone/Fax

Practice location:
  • Phone: 859-273-3888
  • Fax:
Mailing address:
  • Phone: 859-338-3502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3018929
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: