Healthcare Provider Details

I. General information

NPI: 1689954232
Provider Name (Legal Business Name): MOREHEAD STATE UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2011
Last Update Date: 03/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 ALLIE YOUNG HALL
MOREHEAD KY
40351-1684
US

IV. Provider business mailing address

112 ALLIE YOUNG HALL
MOREHEAD KY
40351-1684
US

V. Phone/Fax

Practice location:
  • Phone: 606-783-2885
  • Fax: 606-783-9106
Mailing address:
  • Phone: 606-783-2885
  • Fax: 606-783-9106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number0668
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number03203
License Number StateKY
# 6
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3004857
License Number StateKY
# 7
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3796P
License Number StateKY
# 8
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3002104
License Number StateKY

VIII. Authorized Official

Name: MRS. SHANNON SMITH STEPHENS
Title or Position: DIRECTOR
Credential: DNP, APRN
Phone: 606-783-2123