Provider Demographics
NPI:1063605236
Name:BROWN, STEFANIE YOUNG (RN)
Entity type:Individual
Prefix:
First Name:STEFANIE
Middle Name:YOUNG
Last Name:BROWN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 HEARTLAND DR
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-6297
Mailing Address - Country:US
Mailing Address - Phone:606-305-7972
Mailing Address - Fax:606-678-2004
Practice Address - Street 1:1118 HEARTLAND DR
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-6297
Practice Address - Country:US
Practice Address - Phone:606-305-7972
Practice Address - Fax:606-678-2004
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1075951171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator