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MRS. KLARISA NICOLE STOUDEMIRE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
ARNP

Contact information

Practice address
234 E GRAY ST STE 154, LOUISVILLE, KY 40202-1903
(502) 629-2500
(502) 629-2055
Mailing address
PO BOX 776347, CHICAGO, IL 60677-6347
(502) 588-9490
(502) 272-5116

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
3006498
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000001092683
ANTHEM
KY
01
229581
SIHO
KY
05
300007238
IN
01
50132455
PASSPORT
KY
05
7100172130
KY
01
K008131
MEDICARE
KY
Enumeration date
11/30/2009
Last updated
04/17/2025
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