Provider Demographics
NPI:1235323338
Name:HISER, STACEY (ARNP)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:HISER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 HOSPITAL ST
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:KY
Mailing Address - Zip Code:42633-2416
Mailing Address - Country:US
Mailing Address - Phone:606-340-3251
Mailing Address - Fax:606-340-3266
Practice Address - Street 1:166 HOSPITAL ST
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:KY
Practice Address - Zip Code:42633-2416
Practice Address - Country:US
Practice Address - Phone:606-340-3251
Practice Address - Fax:606-340-3266
Is Sole Proprietor?:No
Enumeration Date:2007-08-31
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3005366363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100116090Medicaid
KY1235323338OtherNPI
000000656939OtherANTHEM BC & BS
KY1235323338Medicare NSC
KYP400025905Medicare PIN