Provider Demographics
NPI: | 1962420406 |
---|---|
Name: | STEPP, DARA J (DO) |
Entity type: | Individual |
Prefix: | |
First Name: | DARA |
Middle Name: | J |
Last Name: | STEPP |
Suffix: | |
Gender: | F |
Credentials: | DO |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 793 EASTERN BYP |
Mailing Address - Street 2: | SUITE 201 |
Mailing Address - City: | RICHMOND |
Mailing Address - State: | KY |
Mailing Address - Zip Code: | 40475-2422 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 859-624-6560 |
Mailing Address - Fax: | 859-624-6569 |
Practice Address - Street 1: | 2195 HARRODSBURG RD STE 125 |
Practice Address - Street 2: | |
Practice Address - City: | LEXINGTON |
Practice Address - State: | KY |
Practice Address - Zip Code: | 40504-3543 |
Practice Address - Country: | US |
Practice Address - Phone: | 859-323-6371 |
Practice Address - Fax: | 859-257-3585 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-07-17 |
Last Update Date: | 2024-06-07 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
TN | 1854 | 208M00000X |
KY | 02970 | 207Q00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | |
No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
KY | 02970 | Other | MEDICAL LICENSE |
KY | 64123771 | Medicaid | |
TN | 1854 | Other | MEDICAL LICENSE |
KY | BS9547158 | Other | DEA |