Provider Demographics
NPI:1003196114
Name:KLASS, STACY JO (CNP)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:JO
Last Name:KLASS
Suffix:
Gender:F
Credentials:CNP
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Mailing Address - Street 1:951 COMMERCE PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45804-4040
Mailing Address - Country:US
Mailing Address - Phone:419-998-4575
Mailing Address - Fax:419-998-4586
Practice Address - Street 1:1005 BELLEFONTAINE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-2851
Practice Address - Country:US
Practice Address - Phone:419-227-5298
Practice Address - Fax:419-227-5879
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-19
Last Update Date:2018-03-05
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Provider Licenses
StateLicense IDTaxonomies
OHCOA12426363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0053941Medicaid
OH0053941Medicaid