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General NPI Number Information
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NPI Number | 1629267315
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Entity Type | Organization
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Legal Business Name | STEPHANIE N. SOUTHARD, PSC
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Dates
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Enumeration Date | 10/18/2007
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Last Update Date | 06/03/2010
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Provider Practice Location Address
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Address Line | 1215 N MAIN ST SUITE 2
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City | MONTICELLO
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State | KY
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Zip | 42633-2900
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Country | US
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Telephone | 606-340-8825
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Fax | 606-340-0097
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Provider Business Mailing Address
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Address Line | 1215 N MAIN ST SUITE 2
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City | MONTICELLO
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State | KY
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Zip | 42633-2900
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Country | US
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Telephone | 606-340-8825
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Fax | 606-340-0097
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEPHANIE NICOLE SOUTHARD
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Credential | D.O.
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Telephone | 606-340-8825
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 02809
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License Number State | KY
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