Active NPI
Anne C Stevenson, MD
- Pediatrics Physician
- Elizabethtown, KY
National Provider Identifier
1932196615
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 39461
- Practice address
- 1207 Woodland Dr
Elizabethtown, KY 42701-2709 - Phone
- (270) 765-2107
- Fax
- (270) 769-9642
- NPI assigned
- Sep 29, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 39461 | KY | Primary |
Addresses
Primary practice location
1207 Woodland Dr
Elizabethtown, KY 42701-2709
Mailing address
PO Box 950202
Louisville, KY 40295-0202
Phone (502) 969-6552
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000379500 | Other | ANTHEM - NCMA | |
| 2633023000 | Other | PAD - NCMA | |
| 068871 | Other | SIHO - NCMA | |
| 64105398 | Medicaid | KY | |
| 50007871 | Other | PASSPORT - NCMA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 39461 | KY | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127952000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1206576000000",
"number": "1932196615",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 950202",
"city": "LOUISVILLE",
"state": "KY",
"postal_code": "402950202",
"telephone_number": "502-969-6552",
"fax_number": "502-969-3799"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1207 WOODLAND DR",
"city": "ELIZABETHTOWN",
"state": "KY",
"postal_code": "427012709",
"telephone_number": "270-765-2107",
"fax_number": "270-769-9642"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STEVENSON",
"first_name": "ANNE",
"middle_name": "C",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-09-29",
"last_updated": "2008-03-27",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "KY",
"license": "39461",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM - NCMA",
"identifier": "000000379500",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PAD - NCMA",
"identifier": "2633023000",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SIHO - NCMA",
"identifier": "068871",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "64105398",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PASSPORT - NCMA",
"identifier": "50007871",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Elizabethtown, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.