Provider Demographics
NPI:1366908519
Name:STOVALL, DEBORAH JEAN (APRN, FNP-C)
Entity type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:JEAN
Last Name:STOVALL
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:MS
Other - First Name:DEBORAH
Other - Middle Name:JEAN
Other - Last Name:STOVALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:320 MICBETH DR
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:KY
Mailing Address - Zip Code:42445-6332
Mailing Address - Country:US
Mailing Address - Phone:270-365-3343
Mailing Address - Fax:
Practice Address - Street 1:320 MICBETH DR
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:KY
Practice Address - Zip Code:42445-6332
Practice Address - Country:US
Practice Address - Phone:270-265-3433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-13
Last Update Date:2019-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3013153363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYC6150Medicaid