Provider Demographics
NPI:1437873049
Name:COWHERD, STACY LYNN (LPN)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:LYNN
Last Name:COWHERD
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:LYNN
Other - Last Name:DELAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:1720 N BOLTON AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46218-5133
Mailing Address - Country:US
Mailing Address - Phone:317-625-4023
Mailing Address - Fax:
Practice Address - Street 1:5550 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-6426
Practice Address - Country:US
Practice Address - Phone:317-352-9157
Practice Address - Fax:317-359-4052
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27059681A164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse