MEDICARE: STANFORD WELLNESS CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1871064428
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STANFORD WELLNESS CENTER

Provider Business Mailing Address
First Line	:	748 REYNOLDS HOLLOW RD
Second Line	:
City	:	JUNCTION CITY
State	:	KY
Zip	:	40440-9537
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	934 LANCASTER ST
Second Line	:
City	:	STANFORD
State	:	KY
Zip	:	40484-1351
Country	:	US
Telephone Number	:	606-661-0246
Fax Number	:	606-661-0327

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	SHARON NAYLOR
Credential	:	APRN
Telephone Number	:	606-875-7418

Provider Enumeration Date	:	12/07/2018
Last Update Date	:	12/07/2018

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Directions to “STANFORD WELLNESS CENTER ” Practice Location

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