Individual
STEPHANIE K PRIDEMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
740 S LIMESTONE STE C300, LEXINGTON, KY 40536-3706
(859) 257-5405
(859) 323-5483
Mailing address
1618 HARRODSBURG RD, LEXINGTON, KY 40504-3706
(859) 288-5004
(859) 288-5007
Taxonomy
Speciality
Code
Description
License number
State
2083X0100X
Occupational Medicine Physician
PA602
KY
363A00000X
Physician Assistant
Primary
PA602
KY
363AM0700X
Medical Physician Assistant
PA602
KY
363AS0400X
Surgical Physician Assistant
PA602
KY
Other
Enumeration date
06/19/2008
Last updated
09/04/2024
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