Provider Demographics
NPI:1861679458
Name:ISLER, STACIE MARIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:STACIE
Middle Name:MARIE
Last Name:ISLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:STACIE
Other - Middle Name:MARIE
Other - Last Name:ROACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:700 ACKERMAN RD STE 570
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1579
Mailing Address - Country:US
Mailing Address - Phone:614-293-8566
Mailing Address - Fax:614-293-3381
Practice Address - Street 1:915 OLENTANGY RIVER RD
Practice Address - Street 2:SUITE 2100
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-3153
Practice Address - Country:US
Practice Address - Phone:614-293-8566
Practice Address - Fax:614-293-3381
Is Sole Proprietor?:No
Enumeration Date:2008-01-25
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.002710363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0081949Medicaid
OH0081949Medicaid