Provider Demographics
NPI:1366003717
Name:LUCAS, STEPHANIE J (APRN)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:J
Last Name:LUCAS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9275 S HIGHWAY 261
Mailing Address - Street 2:
Mailing Address - City:FALLS OF ROUGH
Mailing Address - State:KY
Mailing Address - Zip Code:40119-4121
Mailing Address - Country:US
Mailing Address - Phone:270-903-7100
Mailing Address - Fax:
Practice Address - Street 1:9275 S HIGHWAY 261
Practice Address - Street 2:
Practice Address - City:FALLS OF ROUGH
Practice Address - State:KY
Practice Address - Zip Code:40119-4121
Practice Address - Country:US
Practice Address - Phone:270-903-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3013475363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily