Provider Demographics
NPI:1497248934
Name:HECKARD, STACY (CRNP)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:HECKARD
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 E. PENN AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ROBESONIA
Mailing Address - State:PA
Mailing Address - Zip Code:19551
Mailing Address - Country:US
Mailing Address - Phone:484-987-3456
Mailing Address - Fax:610-693-4574
Practice Address - Street 1:410 E. PENN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ROBESONIA
Practice Address - State:PA
Practice Address - Zip Code:19551
Practice Address - Country:US
Practice Address - Phone:484-987-3456
Practice Address - Fax:610-693-4574
Is Sole Proprietor?:No
Enumeration Date:2018-06-09
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN624672163W00000X
PASP019622363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse