Stephanie M. Russell MD PSC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

STEPHANIE M. RUSSELL MD PSC

Doing business as

KidzLife Pediatrics

Practice address

10639 Meeting Street
Suite 101
Prospect, KY 40059-7544

Phone

(502) 425-7827

Fax

(502) 412-3979

NPI assigned

Oct 31, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Stephanie M. Russell, MD

Title

Owner

Phone

(502) 425-7827

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• KidzLife Pediatrics Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1268265600000",
    "number": "1164508198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10639 MEETING STREET",
            "address_2": "SUITE 101",
            "city": "PROSPECT",
            "state": "KY",
            "postal_code": "400597544",
            "telephone_number": "502-425-7827",
            "fax_number": "502-412-3979"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10639 MEETING STREET",
            "address_2": "SUITE 101",
            "city": "PROSPECT",
            "state": "KY",
            "postal_code": "400597544",
            "telephone_number": "502-425-7827",
            "fax_number": "502-412-3979"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEPHANIE M. RUSSELL MD PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-31",
        "last_updated": "2010-03-11",
        "status": "A",
        "authorized_official_last_name": "RUSSELL",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "502-425-7827",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "KY",
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200314560A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "KidzLife Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Shannon Nichole Smith
• Eva Maria Snadon, TARGET CASE MANAGEME
• John L Snell III, DO
• Abby Lavelle Staffieri, DMD
• Tammy C Stebbins, M.S., SLP
• Laura Elaine Stone, P.T.
• Nicole B Strecker, M.D.
• Rafael Angel Suarez, DMD
• Melanie Kim Summers, LPCC
• Tamella Buss Cassis MD PLLC (Cassis Dermatology & Aesthetics Center)

• Pediatrics Physician in Prospect, KY
• Providers in Prospect, KY by specialty
• Pediatrics Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.