Provider Demographics
NPI:1063463529
Name:STEVENS, RAYMONDA (MD)
Entity Type:Individual
Prefix:
First Name:RAYMONDA
Middle Name:
Last Name:STEVENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7725 WOODBRIDGE HILL LN
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-8699
Mailing Address - Country:US
Mailing Address - Phone:502-751-9214
Mailing Address - Fax:
Practice Address - Street 1:1218 SOUTH BROADWAY
Practice Address - Street 2:SUITE 310
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-2759
Practice Address - Country:US
Practice Address - Phone:859-219-0542
Practice Address - Fax:859-219-9433
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33266174400000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64027402Medicaid
KY0572123Medicare PIN
KYH32171Medicare UPIN