Provider Demographics
NPI:1245313832
Name:YEO, STACEY L (NP)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:L
Last Name:YEO
Suffix:
Gender:
Credentials:NP
Other - Prefix:MRS
Other - First Name:STACEY
Other - Middle Name:L
Other - Last Name:RICHMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:6626 E 75TH ST STE 500
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3500 S LAFOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-3803
Practice Address - Country:US
Practice Address - Phone:765-776-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002266A363LN0000X
IN71002266363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000757425OtherANTHEM BC/BS FOR IU HEALTH ARNETT
IN200859080Medicaid
IN200859080Medicaid
IN200859080Medicaid
IN200859080Medicaid