Provider Demographics
NPI:1609502418
Name:WILLIAMS, STEPHANIE D (RN)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:D
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10203 GREENFIELD PARK RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40258-1787
Mailing Address - Country:US
Mailing Address - Phone:502-851-8775
Mailing Address - Fax:
Practice Address - Street 1:6415 CALM RIVER WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-3250
Practice Address - Country:US
Practice Address - Phone:502-625-6927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1113199163WR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0400XNursing Service ProvidersRegistered NurseRehabilitation