Individual
SHANNA STIVERS DAVE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN-CNP PMHNP-BC
Contact information
Practice address
18 ALEXANDER AVE UNIT 1, BEDFORD, KY 40006-1114
(502) 255-0222
(502) 255-0600
Mailing address
PO BOX 124, EMINENCE, KY 40019-0124
(502) 593-0083
(502) 255-0600
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
4027554
KY
Other
Enumeration date
09/11/2024
Last updated
09/11/2024
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