1760166920 NPI number — STEPHANIE ANNE SCHERTZINGER RN

Table of content: STEPHANIE ANNE SCHERTZINGER RN (NPI 1760166920)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760166920 NPI number — STEPHANIE ANNE SCHERTZINGER RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHERTZINGER
Provider First Name:
STEPHANIE
Provider Middle Name:
ANNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JONES
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1760166920
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
897 BILLY GOAT HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOPKINSVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42240-1146
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-839-1811
Provider Business Mailing Address Fax Number:
931-645-4104

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
647 DUNLOP LN STE 301
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLARKSVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37040-5265
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-461-5015
Provider Business Practice Location Address Fax Number:
931-645-4104
Provider Enumeration Date:
06/09/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WC0400X , with the licence number:  1111572 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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