Individual
STEPHANIE SOUTHARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
166 HOSPITAL ST, MONTICELLO, KY 42633-2430
(606) 340-3251
(606) 348-0618
Mailing address
166 HOSPITAL ST, MONTICELLO, KY 42633-2430
(606) 340-3251
(606) 348-0618
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02809
KY
208M00000X
Hospitalist Physician
02809
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64061807
—
KY
Enumeration date
12/12/2006
Last updated
03/17/2018
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