Stephanie D Landes, FNP-BC
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Corbin, KY
NPI 1972082170 · NPPES record last updated Feb 19, 2020
Key facts
- NPI
- 1972082170
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 3014119 (KY)
- Practice address
- 192 Bacon Creek Rd
Corbin, KY 40701-8639 - Phone
- (606) 526-1900
- NPI assigned
- Aug 8, 2018
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TN, KY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20181031003048 | TN | Practitioner - Nurse Practitioner | 9133472574 | Reassigns benefits to 2 organizations |
| I20200403002202 | KY | Practitioner - Nurse Practitioner | 9133472574 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24514 | TN | MD | Family Nurse Practitioner |
| 3014119 | KY | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| PPL Therapeutic Services PLLC | Multi-Specialty | Current |
Accepting new patients |
| App of Tennessee HM, PLLC | Multi-Specialty | Current |
Accepting new patients |
| Velocity Medical LLC | Multi-Specialty | Current |
Accepting new patients |
| Kayla Lesher Aprn, PLLC | Psychiatric/Mental Health | Past | Accepting new patients |
Locations
192 Bacon Creek Rd
Corbin, KY 40701
Phone (606) 526-1900
100 Carmel Manor Dr
Fort Thomas, KY 41075
Phone (859) 781-5111
555 Bourne Ave
Somerset, KY 42501
Phone (606) 679-7421
120 Tanner Pl
Clinton, TN 37716
Phone (865) 264-4012
106 Medical Center Blvd
Fayetteville, TN 37334
Phone (931) 438-1100
2702 Jacksboro Pike
Jacksboro, TN 37757
Phone (423) 201-9937
7565 Dannaher Dr
Powell, TN 37849
Phone (865) 545-8000
2835 Highway 231 N
Shelbyville, TN 37160
Phone (931) 685-5433
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 24514 | TN | |
| Psychiatric/Mental Health Nurse Practitioner |
363LP0808X | 3014119 | KY | Yes |
Addresses
Primary practice location
192 Bacon Creek Rd
Corbin, KY 40701-8639
Mailing address
106 Old Wooldridge Pike
Jellico, TN 37762-3518
Phone (423) 201-3161
Other practice location 1
287 Baker St
Huntsville, TN 37756-3444
Phone (423) 663-3600
Other providers in Corbin, KY
- Alex Edward Lamb
- Jason W Lambdin
- Lauren Lambdin
- Emily Lambert
- Kimberly Renee Lambert
- Tony Wayne Landrum
- Tommy Lanham
- Callie Mackenzie Lankford
- Kayla Lankheit
- Kelli Lassiter
All providers in Corbin, KY · Psychiatric/Mental Health Nurse Practitioner in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 19, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.