Basic Information
| Provider Information | |||||||||
| NPI: | 1346802766 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOVERMALE | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | FNP | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HOVERMALE | ||||||||
| OtherFirstName: | STEVEN | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | FNP | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1056 TWIN OAKS BLVD | ||||||||
| Address2: | |||||||||
| City: | MOUNT STERLING | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403537000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6063361380 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 125 FOXGLOVE DR STE D | ||||||||
| Address2: | |||||||||
| City: | MOUNT STERLING | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403539735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8594983333 | ||||||||
| FaxNumber: | 8594983332 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2019 | ||||||||
| LastUpdateDate: | 11/03/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 1134462 | KY | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 3013599 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 3013599 | 01 | KY | KY APRN LICENSE | OTHER |