Provider Demographics
NPI:1003677618
Name:KEESEE, STACIA JEAN (STNA)
Entity Type:Individual
Prefix:
First Name:STACIA
Middle Name:JEAN
Last Name:KEESEE
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1095 W NORTH BEND RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45224-2247
Mailing Address - Country:US
Mailing Address - Phone:770-609-7629
Mailing Address - Fax:
Practice Address - Street 1:1095 W NORTH BEND RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45224-2247
Practice Address - Country:US
Practice Address - Phone:770-609-7629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health