Healthcare Provider Details

I. General information

NPI: 1932660602
Provider Name (Legal Business Name): CATHERINE ELIZABETH STACKS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 KY ROUTE 321 STE 2127
PRESTONSBURG KY
41653-9113
US

IV. Provider business mailing address

5000 KY ROUTE 321 STE 2127
PRESTONSBURG KY
41653-9113
US

V. Phone/Fax

Practice location:
  • Phone: 606-889-6255
  • Fax: 606-889-6256
Mailing address:
  • Phone: 606-889-6255
  • Fax: 606-889-6256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number56958
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: