Provider Demographics
NPI:1972522340
Name:STEVENS, JUDY L (ARNP)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:L
Last Name:STEVENS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 DESTINY LN
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-1087
Mailing Address - Country:US
Mailing Address - Phone:270-781-1101
Mailing Address - Fax:270-781-1120
Practice Address - Street 1:1830 DESTINY LN
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-1087
Practice Address - Country:US
Practice Address - Phone:270-781-1101
Practice Address - Fax:270-781-1120
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4356P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78013109Medicaid
KYQ27974Medicare UPIN