Provider Demographics
NPI:1083382915
Name:GHOLZ, STACY (FNP-C)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:GHOLZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3876 STATE HIGHWAY ZZ
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MO
Mailing Address - Zip Code:65610-9068
Mailing Address - Country:US
Mailing Address - Phone:417-300-2441
Mailing Address - Fax:
Practice Address - Street 1:960 E WALNUT LAWN ST STE 200
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-7865
Practice Address - Country:US
Practice Address - Phone:417-269-4450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-03
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021035415363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner