Organization
STEPHANIE N. SOUTHARD, PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHANIE NICOLE SOUTHARD D.O. (PRESIDENT)
(606) 340-8825
Entity
Organization
Contact information
Practice address
1215 N MAIN ST, SUITE 2, MONTICELLO, KY 42633-2900
(606) 340-8825
(606) 340-0097
Mailing address
1215 N MAIN ST, SUITE 2, MONTICELLO, KY 42633-2900
(606) 340-8825
(606) 340-0097
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
02809
KY
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64061807
—
KY
Enumeration date
10/18/2007
Last updated
06/03/2010
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