Provider Demographics
NPI:1386192300
Name:BYRNE, STEPHANIE ANN (APRN)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANN
Last Name:BYRNE
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 1:13802 LAKE POINT CIR STE 102
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-4219
Mailing Address - Country:US
Mailing Address - Phone:502-245-4450
Mailing Address - Fax:502-245-4462
Practice Address - Street 1:13802 LAKE POINT CIR STE 102
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-4219
Practice Address - Country:US
Practice Address - Phone:502-245-4450
Practice Address - Fax:502-245-4462
Is Sole Proprietor?:No
Enumeration Date:2016-09-19
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3010706363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily