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NPI Code Detail

MEDICARE: STEPHANIE L MUNDY APRN

MEDICARE: STEPHANIE L MUNDY APRN
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
1363L00000XNurse Practitioner3006634KY
2363LF0000XFamily Nurse Practitioner3006634KY
3163W00000XRegistered Nurse1076284KY
4207RC0000XCardiovascular Disease Physician3006634KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1912212143
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE L MUNDY APRN
Provider Business Mailing Address
First Line : 100 MEDICAL CENTER DR
Second Line :
City : PRINCETON
State : KY
Zip : 42445-2430
Country : US
Telephone Number : 270-365-0300
Fax Number :
Provider Business Practice Location Address
First Line : 100 MEDICAL CENTER DR
Second Line :
City : PRINCETON
State : KY
Zip : 42445-2430
Country : US
Telephone Number : 270-365-0300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2010
Last Update Date : 06/19/2024

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Directions to “ STEPHANIE L MUNDY APRN” Practice Location

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