Healthcare Provider Details

I. General information

NPI: 1265073548
Provider Name (Legal Business Name): STEPHEN FAEHR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2019
Last Update Date: 10/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 S MAIN CROSS ST
LOUISA KY
41230-1065
US

IV. Provider business mailing address

PO BOX 726
LOUISA KY
41230-0726
US

V. Phone/Fax

Practice location:
  • Phone: 606-638-0938
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: