Provider Demographics
NPI:1255966172
Name:SIGRIMIS, STEPHEN GEORGE
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:GEORGE
Last Name:SIGRIMIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-1529
Mailing Address - Country:US
Mailing Address - Phone:606-770-5121
Mailing Address - Fax:606-770-5199
Practice Address - Street 1:1102 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-1529
Practice Address - Country:US
Practice Address - Phone:606-770-5121
Practice Address - Fax:606-770-5199
Is Sole Proprietor?:No
Enumeration Date:2020-03-11
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3014239363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100864050Medicaid