Individual
STACEY WARING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3950 KRESGE WAY, SUITE 303, LOUISVILLE, KY 40207-4637
(502) 896-6696
(502) 896-1795
Mailing address
PO BOX 950248, LOUISVILLE, KY 40295-0248
(502) 489-5730
(502) 489-5753
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
35865
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50018552
PASSPORT
KY
05
—
6405288900
—
KY
Enumeration date
01/25/2007
Last updated
12/10/2020
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