Provider Demographics
NPI:1255545794
Name:WARD, STEPHANIE ELAINE (RN)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:ELAINE
Last Name:WARD
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:PO BOX 12
Mailing Address - Street 2:68 CARMICHAEL DR.
Mailing Address - City:CLAY CITY
Mailing Address - State:KY
Mailing Address - Zip Code:40312-0012
Mailing Address - Country:US
Mailing Address - Phone:606-663-3421
Mailing Address - Fax:
Practice Address - Street 1:68 CARMICHAEL DR.
Practice Address - Street 2:
Practice Address - City:CLAY CITY
Practice Address - State:KY
Practice Address - Zip Code:40312-0012
Practice Address - Country:US
Practice Address - Phone:606-663-3421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1086635163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse