Provider Demographics
NPI:1922887009
Name:CONRAD, STACEY LYNN
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:LYNN
Last Name:CONRAD
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 1:4838 JUDSON RD
Mailing Address - Street 2:
Mailing Address - City:ALDERSON
Mailing Address - State:WV
Mailing Address - Zip Code:24910-4530
Mailing Address - Country:US
Mailing Address - Phone:304-661-2372
Mailing Address - Fax:
Practice Address - Street 1:4838 JUDSON RD
Practice Address - Street 2:
Practice Address - City:ALDERSON
Practice Address - State:WV
Practice Address - Zip Code:24910-4530
Practice Address - Country:US
Practice Address - Phone:304-661-2372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker