Provider Demographics
NPI:1578920815
Name:CARRUTH, STACIE (APRN, CNP)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:
Last Name:CARRUTH
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:477 COOPER RD STE 200
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-8054
Mailing Address - Country:US
Mailing Address - Phone:614-459-7676
Mailing Address - Fax:614-459-7681
Practice Address - Street 1:477 COOPER RD STE 200
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-8054
Practice Address - Country:US
Practice Address - Phone:614-459-7676
Practice Address - Fax:614-459-7681
Is Sole Proprietor?:No
Enumeration Date:2016-01-18
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA 18625-NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health