Organization
STEPHANIE M. RUSSELL MD PSC
Active
Other names
KidzLife Pediatrics
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE M. RUSSELL MD (OWNER)
(502) 425-7827
Entity
Organization
Contact information
Practice address
10639 MEETING STREET, SUITE 101, PROSPECT, KY 40059-7544
(502) 425-7827
(502) 412-3979
Mailing address
10639 MEETING STREET, SUITE 101, PROSPECT, KY 40059-7544
(502) 425-7827
(502) 412-3979
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
KY
363LF0000X
Family Nurse Practitioner
—
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200314560A
—
IN
Enumeration date
10/31/2006
Last updated
03/11/2010
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