Provider Demographics
NPI:1215968003
Name:SMITH-STEPHENS, SHANNON LEIGH (DNP, APRN)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:LEIGH
Last Name:SMITH-STEPHENS
Suffix:
Gender:F
Credentials:DNP, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6902B GRAHN RD
Mailing Address - Street 2:
Mailing Address - City:OLIVE HILL
Mailing Address - State:KY
Mailing Address - Zip Code:41164-8147
Mailing Address - Country:US
Mailing Address - Phone:606-922-0121
Mailing Address - Fax:606-548-5019
Practice Address - Street 1:6902B GRAHN RD
Practice Address - Street 2:
Practice Address - City:OLIVE HILL
Practice Address - State:KY
Practice Address - Zip Code:41164-8147
Practice Address - Country:US
Practice Address - Phone:606-922-0121
Practice Address - Fax:606-548-5019
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3003796363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000609845OtherANTHEM BCBS
KY78010220Medicaid
OH2826311Medicaid
KY000000298213OtherANTHEM BCBS
KY0643016Medicare PIN
KY00934011Medicare PIN
KY000000609845OtherANTHEM BCBS
KY0631719Medicare PIN