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Individual

STACEY M ANDERSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
APRN

Contact information

Practice address
1225 S BROADWAY STE 201, LEXINGTON, KY 40504-2701
(859) 258-4950
(859) 258-4618
Mailing address
1221 S BROADWAY, LEXINGTON, KY 40504-2701
(859) 258-6200
(859) 258-6203

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
3009247
KY
363LF0000X
Family Nurse Practitioner
3009247
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
7100351200
KY
Enumeration date
03/18/2015
Last updated
12/02/2024
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