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General NPI Number Information
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NPI Number | 1285231258
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Entity Type | Individual
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Provider Name | ALICIA D STIDAM APRN, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 10/02/2020
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Last Update Date | 03/18/2021
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Provider Practice Location Address
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Address Line | 245 FLEMINGSBURG RD
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City | MOREHEAD
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State | KY
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Zip | 40351-1015
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Country | US
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Telephone | 606-780-5500
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Fax | 606-783-7281
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Provider Business Mailing Address
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Address Line | 41 HOMEPLACE WAY
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City | MOREHEAD
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State | KY
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Zip | 40351-9071
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Country | US
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Telephone | 606-784-5894
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 3015232
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 3015232
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License Number State | KY
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