Healthcare Provider Details

I. General information

NPI: 1518375443
Provider Name (Legal Business Name): STEPHANIE BURRES ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2014
Last Update Date: 05/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2529 SIX MILE LN
LOUISVILLE KY
40220-2934
US

IV. Provider business mailing address

12201 BLUEGRASS PKWY
LOUISVILLE KY
40299-2361
US

V. Phone/Fax

Practice location:
  • Phone: 502-491-5560
  • Fax: 502-491-0214
Mailing address:
  • Phone: 502-568-7366
  • Fax: 502-568-7114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN3008764
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number3008764
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number3008764
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: