Provider Demographics
NPI:1881650414
Name:ECKERLE, STEPHANIE B (PA-C)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:B
Last Name:ECKERLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 236
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47006-0236
Mailing Address - Country:US
Mailing Address - Phone:812-933-5441
Mailing Address - Fax:812-933-5446
Practice Address - Street 1:26 SIX PINE RANCH RD
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:IN
Practice Address - Zip Code:47006-1399
Practice Address - Country:US
Practice Address - Phone:812-933-3765
Practice Address - Fax:812-933-3766
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.003971363A00000X
IN10000760A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300006468Medicaid
IN201165290Medicaid
INOPRMedicaid
OH0097804Medicaid
INOPRMedicaid
IN259370017Medicare PIN