Provider Demographics
NPI:1982202776
Name:HAMM, STEPHANIE BRIANNE
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:BRIANNE
Last Name:HAMM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 PHEASANT RUN CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-9099
Mailing Address - Country:US
Mailing Address - Phone:859-582-0013
Mailing Address - Fax:
Practice Address - Street 1:801 EASTERN BYP
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2751
Practice Address - Country:US
Practice Address - Phone:859-623-3131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3015062363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner