Healthcare Provider Details

I. General information

NPI: 1952840894
Provider Name (Legal Business Name): STEPHANIE MICHELLE PORTER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2017
Last Update Date: 01/28/2020
Certification Date: 01/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 VETERANS DR
LEXINGTON KY
40502-2235
US

IV. Provider business mailing address

1858 INDIAN CREEK RD
HILLSBORO KY
41049-8773
US

V. Phone/Fax

Practice location:
  • Phone: 859-233-4511
  • Fax:
Mailing address:
  • Phone: 606-356-0688
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3011066
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: