Provider Demographics
NPI: | 1497814560 |
---|---|
Name: | REYHER, STACY B (CRNA) |
Entity Type: | Individual |
Prefix: | |
First Name: | STACY |
Middle Name: | B |
Last Name: | REYHER |
Suffix: | |
Gender: | F |
Credentials: | CRNA |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 191 BILTMORE AVENUE |
Mailing Address - Street 2: | |
Mailing Address - City: | ASHEVILLE |
Mailing Address - State: | NC |
Mailing Address - Zip Code: | 28801-4109 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 828-254-0881 |
Mailing Address - Fax: | 828-254-1614 |
Practice Address - Street 1: | 191 BILTMORE AVENUE |
Practice Address - Street 2: | |
Practice Address - City: | ASHEVILLE |
Practice Address - State: | NC |
Practice Address - Zip Code: | 28801-4109 |
Practice Address - Country: | US |
Practice Address - Phone: | 828-254-0881 |
Practice Address - Fax: | 828-254-1614 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-12-06 |
Last Update Date: | 2023-04-03 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NC | 200187 | 163W00000X |
TN | 070150 | 367500000X |
NC | 002695 | 367500000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 367500000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | |
No | 163W00000X | Nursing Service Providers | Registered Nurse |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
NC | 8052162 | Medicaid | |
NC | 2608246 | Medicare PIN |