Provider Demographics
NPI:1164625190
Name:JOHNS, STACIE LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:STACIE
Middle Name:LYNN
Last Name:JOHNS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 WEST LAKE STREET
Mailing Address - Street 2:SUITE 1500
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-4124
Mailing Address - Country:US
Mailing Address - Phone:970-237-8200
Mailing Address - Fax:970-237-8291
Practice Address - Street 1:151 W LAKE ST STE 1500
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-4124
Practice Address - Country:US
Practice Address - Phone:970-237-8200
Practice Address - Fax:970-237-8291
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO46035207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO023002OtherKAISER COMMERCIAL NUMBER
CO78152208Medicaid
COCOA108714Medicare PIN
COCO301605Medicare UPIN