NPIMap

Organization Active NPI

Stephanie N. Southard, PSC

  • Primary Care Clinic/Center
  • Monticello, KY
National Provider Identifier
1629267315
Registry record updated Jun 3, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
02809 Issued in KY
Legal business name
STEPHANIE N. SOUTHARD, PSC
Practice address
1215 N Main St
Suite 2
Monticello, KY 42633-2900
Phone
(606) 340-8825
Fax
(606) 340-0097
NPI assigned
Oct 18, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2010

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

Authorized official

Name
Dr. Stephanie Nicole Southard, D.O.
Title
President
Phone
(606) 340-8825

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 02809 KY Primary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

1215 N Main St
Suite 2
Monticello, KY 42633-2900

Mailing address

1215 N Main St
Suite 2
Monticello, KY 42633-2900
Phone (606) 340-8825

Other identifiers 1

IdentifierTypeStateIssuer
64061807MedicaidKY

National Provider Directory

National Provider Directory

Locations

1215 N Main St
Ste 2
Monticello, KY 42633
Phone (606) 340-8825

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1192665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1275523200000",
    "number": "1629267315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1215 N MAIN ST",
            "address_2": "SUITE 2",
            "city": "MONTICELLO",
            "state": "KY",
            "postal_code": "426332900",
            "telephone_number": "606-340-8825",
            "fax_number": "606-340-0097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1215 N MAIN ST",
            "address_2": "SUITE 2",
            "city": "MONTICELLO",
            "state": "KY",
            "postal_code": "426332900",
            "telephone_number": "606-340-8825",
            "fax_number": "606-340-0097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STEPHANIE N. SOUTHARD, PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-18",
        "last_updated": "2010-06-03",
        "status": "A",
        "authorized_official_last_name": "SOUTHARD",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_middle_name": "NICOLE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "606-340-8825",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "KY",
            "license": "02809",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "64061807",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Monticello, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 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.