Provider Demographics
NPI:1891811758
Name:POEHNER, STACEY L (NP)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:L
Last Name:POEHNER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 950293
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0293
Mailing Address - Country:US
Mailing Address - Phone:888-987-1875
Mailing Address - Fax:405-609-1491
Practice Address - Street 1:1707 CEDAR GROVE RD
Practice Address - Street 2:SUITE 20
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-8572
Practice Address - Country:US
Practice Address - Phone:502-215-2090
Practice Address - Fax:502-215-5095
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY4197363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY710089470Medicaid
KY710089470Medicaid