Healthcare Provider Details

I. General information

NPI: 1922881325
Provider Name (Legal Business Name): STEPHANIE MICHELLE HOBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2023
Last Update Date: 09/27/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2603 KENTUCKY AVE
PADUCAH KY
42003-3814
US

IV. Provider business mailing address

2603 KENTUCKY AVE
PADUCAH KY
42003-3814
US

V. Phone/Fax

Practice location:
  • Phone: 270-415-4802
  • Fax:
Mailing address:
  • Phone: 270-415-4802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4008442
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: