Healthcare Provider Details

I. General information

NPI: 1003486804
Provider Name (Legal Business Name): STEPHANIE LAUREN AVDAGIC DNP, APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2021
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7870 E KEMPER RD STE 150
CINCINNATI OH
45249-1675
US

IV. Provider business mailing address

2219 LOWELL AVE
LOUISVILLE KY
40205-2652
US

V. Phone/Fax

Practice location:
  • Phone: 513-699-9090
  • Fax: 513-258-2053
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3016054
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: