Healthcare Provider Details

I. General information

NPI: 1609217868
Provider Name (Legal Business Name): STONE FAMILY PRACTICE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2013
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1019 PADUCAH RD STE B
MAYFIELD KY
42066-3616
US

IV. Provider business mailing address

1019 PADUCAH RD STE B
MAYFIELD KY
42066-3616
US

V. Phone/Fax

Practice location:
  • Phone: 270-970-0924
  • Fax: 866-985-7514
Mailing address:
  • Phone: 270-970-0924
  • Fax: 866-985-7514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD DARREN STONE
Title or Position: OWNER/PHYSICIAN
Credential: DO
Phone: 270-804-7408