Provider Demographics
NPI:1235852005
Name:LITTERAL, STACIE NICOLE (APRN)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:NICOLE
Last Name:LITTERAL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 HUFF ST
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:KY
Mailing Address - Zip Code:41143-1321
Mailing Address - Country:US
Mailing Address - Phone:606-316-5972
Mailing Address - Fax:
Practice Address - Street 1:613 23RD ST STE 430
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2885
Practice Address - Country:US
Practice Address - Phone:606-408-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3018415363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner