Healthcare Provider Details

I. General information

NPI: 1225695851
Provider Name (Legal Business Name): SHANNON L. SMITH-STEPHENS, DNP, APRN-BC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2019
Last Update Date: 07/12/2021
Certification Date: 07/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6902B GRAHN RD
OLIVE HILL KY
41164-8147
US

IV. Provider business mailing address

6902B GRAHN RD
OLIVE HILL KY
41164-8147
US

V. Phone/Fax

Practice location:
  • Phone: 606-922-0121
  • Fax: 606-548-5019
Mailing address:
  • Phone: 606-286-0440
  • Fax: 606-548-5019

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. SHANNON LEIGH SMITH-STEPHENS
Title or Position: PROVIDER/SUPPLIER
Credential: DNP, APRN-BC
Phone: 606-286-0440