Provider Demographics
NPI:1912991969
Name:STEVENS, KATHLEEN MARIE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:MARIE
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 1:545 LEVI BEAMS RD
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:KY
Mailing Address - Zip Code:42757-7960
Mailing Address - Country:US
Mailing Address - Phone:270-324-3085
Mailing Address - Fax:
Practice Address - Street 1:289 IRELAND AVE.
Practice Address - Street 2:BUILDING 851
Practice Address - City:FORT KNOX
Practice Address - State:KY
Practice Address - Zip Code:40121-5111
Practice Address - Country:US
Practice Address - Phone:502-624-4031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2403P363LF0000X
KY2403M367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78240306Medicaid
KY78240306Medicaid
Q61271Medicare UPIN