Provider Demographics
NPI:1003470428
Name:HOMAN, STACY A (CSFA/CST)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:A
Last Name:HOMAN
Suffix:
Gender:F
Credentials:CSFA/CST
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:A
Other - Last Name:HOMAN-CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSFA/CST
Mailing Address - Street 1:3333 BURNET AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3333 BURNET AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3039
Practice Address - Country:US
Practice Address - Phone:513-636-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-01
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH156449208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery