Provider Demographics
NPI:1669820882
Name:SPILLER, STACY
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:SPILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 NATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-1431
Mailing Address - Country:US
Mailing Address - Phone:859-299-0068
Mailing Address - Fax:859-422-5023
Practice Address - Street 1:721 NATIONAL AVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502-1431
Practice Address - Country:US
Practice Address - Phone:859-299-0068
Practice Address - Fax:859-422-5023
Is Sole Proprietor?:No
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYEVC10003171W00000X
171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications
No171W00000XOther Service ProvidersContractor