Provider Demographics
NPI:1316585474
Name:COYLE, STACEY ALLEN (CRNP)
Entity Type:Individual
Prefix:MR
First Name:STACEY
Middle Name:ALLEN
Last Name:COYLE
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 CHADWICK ST
Mailing Address - Street 2:
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-1851
Mailing Address - Country:US
Mailing Address - Phone:412-741-2810
Mailing Address - Fax:412-741-2807
Practice Address - Street 1:500 CHADWICK ST
Practice Address - Street 2:
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143-1851
Practice Address - Country:US
Practice Address - Phone:412-741-2810
Practice Address - Fax:412-741-2807
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-19
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP021454363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily