Healthcare Provider Details

I. General information

NPI: 1093619991
Provider Name (Legal Business Name): STEPHANIE RENE HOWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2050 LEXINGTON RD
VERSAILLES KY
40383-1738
US

IV. Provider business mailing address

794 LANGLEY VIEW CT
LOGANVILLE GA
30052-8707
US

V. Phone/Fax

Practice location:
  • Phone: 859-251-4700
  • Fax:
Mailing address:
  • Phone: 770-845-0003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN330089
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: