Healthcare Provider Details

I. General information

NPI: 1982793956
Provider Name (Legal Business Name): LISA B STEPHENS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA B LYON MD

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 FRANKFORT RD STE 101
SHELBYVILLE KY
40065-7401
US

IV. Provider business mailing address

PO BOX 776879
CHICAGO IL
60677-6879
US

V. Phone/Fax

Practice location:
  • Phone: 502-647-5468
  • Fax: 502-647-7134
Mailing address:
  • Phone: 502-588-9490
  • Fax: 502-272-5116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number40028
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: