Provider Demographics
NPI:1083613079
Name:GAUZE, STEVEN M (ARNP)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:M
Last Name:GAUZE
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 BLACKLOG RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:INEZ
Mailing Address - State:KY
Mailing Address - Zip Code:41224-9019
Mailing Address - Country:US
Mailing Address - Phone:606-298-7405
Mailing Address - Fax:606-298-3284
Practice Address - Street 1:2160 BLACKLOG RD
Practice Address - Street 2:SUITE 120
Practice Address - City:INEZ
Practice Address - State:KY
Practice Address - Zip Code:41224-9019
Practice Address - Country:US
Practice Address - Phone:606-298-7405
Practice Address - Fax:606-298-3284
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3004341364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78012770Medicaid
WV3810001297Medicaid
WV3810001297Medicaid
KYQ24762Medicare UPIN
KYMG1486061OtherDEA
KY0319615Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER