Individual provider Active NPI

Dawn Renee Stotts, P.T.A.

  • Skilled Nursing Facility
  • Liberty, KY
National Provider Identifier
1982866893
Registry record updated Sep 29, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
A00712 Issued in KY
Practice address
616 S Wallace Wilkinson Blvd
Liberty, KY 42539-3344
Phone
(606) 787-6889
NPI assigned
Jul 1, 2008
Last updated
Sep 29, 2026By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 29, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X A00712 KY Primary

Addresses

Primary practice location

616 S Wallace Wilkinson Blvd
Liberty, KY 42539-3344

Mailing address

623 Sano Rd
Columbia, KY 42728-7390
Phone (270) 384-0029

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
A00712KYMDSkilled Nursing Facility

NPI Registry JSON

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

{
    "created_epoch": "1214870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1790640000000",
    "number": "1982866893",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "623 SANO RD",
            "city": "COLUMBIA",
            "state": "KY",
            "postal_code": "427287390",
            "telephone_number": "270-384-0029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "616 S WALLACE WILKINSON BLVD",
            "city": "LIBERTY",
            "state": "KY",
            "postal_code": "425393344",
            "telephone_number": "606-787-6889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STOTTS",
        "first_name": "DAWN",
        "middle_name": "RENEE",
        "name_prefix": "Mrs.",
        "credential": "P.T.A.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-07-01",
        "last_updated": "2026-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "KY",
            "license": "A00712",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Liberty, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2026; 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.