Provider Demographics
NPI:1629126123
Name:APPLEGATE, STEPHEN M (MS)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:M
Last Name:APPLEGATE
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-1459
Mailing Address - Country:US
Mailing Address - Phone:859-382-0132
Mailing Address - Fax:859-881-1499
Practice Address - Street 1:100 W OAK ST
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-1244
Practice Address - Country:US
Practice Address - Phone:859-382-0132
Practice Address - Fax:859-881-1499
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY162103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30615058Medicaid
KY0454Medicare ID - Type UnspecifiedMEDICARE