Stephanie Jill Braverman, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

0101271008 Issued in VA

Practice address

650 Joel Dr
Fort Campbell, KY 42223-5318

Phone

(270) 798-8258

NPI assigned

Apr 2, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1554163200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686614400000",
    "number": "1447712294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 JOEL DR",
            "city": "FORT CAMPBELL",
            "state": "KY",
            "postal_code": "422235318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 JOEL DR",
            "city": "FORT CAMPBELL",
            "state": "KY",
            "postal_code": "422235318",
            "telephone_number": "270-798-8258"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRAVERMAN",
        "first_name": "STEPHANIE",
        "middle_name": "JILL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-02",
        "last_updated": "2023-06-13",
        "certification_date": "2023-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "VA",
            "license": "0101271008",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "VA",
            "license": "0101271008",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNLICENSED PROVIDER",
            "identifier": "39020000X",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Paris Monique Branch
• Jason Andrew Brandi, PT
• Mary Brandon, LCSW
• Rodney Kenneth Brannan, AU.D.
• Katrina L Bratton, PH.D.
• Noah Brayton, DDS
• Monta Annette Breeden, LCSW LMT
• Olivia Marie Brem, OTD
• Morgan Brewer, MS. ATC/L, CSCS, CES
• Juliette Carrington Bridgeman, WHNP

• Pediatrics Physician in Fort Campbell, KY
• Providers in Fort Campbell, KY by specialty
• Pediatrics Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2023; 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.