Provider Demographics
NPI:1629007620
Name:STEPHENS, LEONA JEAN (MD)
Entity Type:Individual
Prefix:
First Name:LEONA
Middle Name:JEAN
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 950202
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0202
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:3118 E 10TH ST
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-5904
Practice Address - Country:US
Practice Address - Phone:812-282-6979
Practice Address - Fax:812-282-6998
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01059486A207Q00000X
KY40465207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0538679OtherMEDICARE NGS--IQ
KY64129281Medicaid
0637745OtherMEDICARE NGS--PO
0795618OtherMEDICARE NGS--ZE
0538494OtherMEDICARE NGS--EB
0538577OtherMEDICARE NGS--FD
0538778OtherMEDICARE NGS--PX
IN200493190Medicaid
0538679OtherMEDICARE NGS--IQ