Provider Demographics
NPI:1063023166
Name:KORN, STEPHANIE BLYTHE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:BLYTHE
Last Name:KORN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9229 FOX RUN DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7443
Mailing Address - Country:US
Mailing Address - Phone:917-583-8107
Mailing Address - Fax:
Practice Address - Street 1:9229 FOX RUN DR
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-7443
Practice Address - Country:US
Practice Address - Phone:917-583-8107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY695853-01163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health