| Organization Name: | STEPHANIE M. RUSSELL MD PSC |
| NPI Number: | 1164508198 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | STEPHANIE M. RUSSELL (OWNER) |
| Mailing Address: | 10639 Meeting Street Suite 101 Prospect |
| State: | KY US |
| Postal Code: | 400597544 |
| Phone Number: | 5024257827 |
| Fax Number: | 5024123979 |
| NPI Enumeration Date: | 10/31/2006 |
| NPI Last Update Date: | 03/11/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | KY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |