Individual
WANDA RAYE STIDHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
181 ROY CAMPBELL DR, HAZARD, KY 41701-9407
(606) 439-1316
Mailing address
453 OLD KY 11, BOONEVILLE, KY 41314-9171
(606) 593-6400
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
4042301
KY
Other
Enumeration date
06/06/2025
Last updated
05/08/2026
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