Glenda Sue Stidham, IECE CERTIFIED

Primary specialty

State or Local Public Health Clinic/CenterTaxonomy code 261QP0905X

License

01984 Issued in KY

Practice address

57 Miller Rd
Manchester, KY 40962-5714

Phone

(606) 598-2815

Fax

(606) 598-0148

NPI assigned

May 29, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1180396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1598966459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "57 MILLER RD",
            "city": "MANCHESTER",
            "state": "KY",
            "postal_code": "409625714",
            "telephone_number": "606-598-2815",
            "fax_number": "606-598-0148"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "57 MILLER RD",
            "city": "MANCHESTER",
            "state": "KY",
            "postal_code": "409625714",
            "telephone_number": "606-598-2815",
            "fax_number": "606-598-0148"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STIDHAM",
        "first_name": "GLENDA",
        "middle_name": "SUE",
        "name_prefix": "Mrs.",
        "credential": "IECE CERTIFIED",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QP0905X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Public Health, State or Local",
            "state": "KY",
            "license": "01984",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEVELOPMENTAL INTERVENTIO",
            "identifier": "01984",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• State or Local Public Health Clinic/Center in Manchester, KY
• Providers in Manchester, KY by specialty
• State or Local Public Health Clinic/Center in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.