Individual
MRS. STEPHANIE TICHENOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
210 E GRAY ST STE 1105, LOUISVILLE, KY 40202-3907
(502) 583-1697
(502) 583-2120
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
1096981
KY
363L00000X
Nurse Practitioner
Primary
3005412
KY
363L00000X
Nurse Practitioner
5412P
KY
363LF0000X
Family Nurse Practitioner
3005412
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000696981
ANTHEM- NNIKY
KY
01
—
000040710
HUMANA- NNIKY
KY
01
—
093360
SIHO- NNIKY
KY
05
—
200884950
—
IN
01
—
50031587
PASSPORT- NNIKY
KY
05
—
7100040710
—
KY
01
—
8960504
CIGNA- NNIKY
KY
01
—
9152454
AETNA- NNIKY
KY
01
—
P00948802
RAILROAD MEDICARE
KY
Enumeration date
06/13/2007
Last updated
01/22/2021
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