Provider Demographics
NPI:1235241696
Name:NAULTY, STUART A (DPM)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:A
Last Name:NAULTY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 B SOUTH 12TH ST
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-2949
Mailing Address - Country:US
Mailing Address - Phone:270-753-0666
Mailing Address - Fax:270-753-0684
Practice Address - Street 1:908 B SOUTH 12TH ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-2949
Practice Address - Country:US
Practice Address - Phone:270-753-0666
Practice Address - Fax:270-753-0684
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY00160213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY80001605Medicaid
KY000000052090OtherBLUE SHIELD
KY90005646Medicaid
KY90005646Medicaid
KY000000052090OtherBLUE SHIELD
KYT54194Medicare UPIN
KY0584001Medicare ID - Type UnspecifiedBENTON MEDICARE