Individual
STACEY STOKES ROUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
439 COUNTRY LN, LOUISVILLE, KY 40207-1803
(502) 939-5378
Mailing address
439 COUNTRY LN, LOUISVILLE, KY 40207-1803
(502) 939-5378
(502) 272-5337
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
35005
KY
2080A0000X
Pediatric Adolescent Medicine Physician
35005
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000200556
ANTHEM
KY
01
—
000000739400
ANTHEM - KCMA
KY
01
—
129357
SIHO - KCMA
KY
01
—
50035679
PASSPORT - KCMA
KY
01
—
611356201
TAX ID
KY
05
—
64035678
—
KY
Enumeration date
01/30/2007
Last updated
05/08/2024
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