Provider Demographics
NPI:1942716758
Name:RATLIFF, STACEY R (PA)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:R
Last Name:RATLIFF
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8250 KENWOOD CROSSING WAY STE 201
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45236-3669
Mailing Address - Country:US
Mailing Address - Phone:888-926-6398
Mailing Address - Fax:800-420-3481
Practice Address - Street 1:6499 S MASON MONTGOMERY RD STE C
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-1773
Practice Address - Country:US
Practice Address - Phone:513-760-5511
Practice Address - Fax:513-781-9600
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-18
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
OH50.0006081363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty