Provider Demographics
NPI:1245952530
Name:GRIFFIN, STACY LYNN (MSN, APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:LYNN
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:MSN, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5128 E STOP 11 RD STE 34
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-6338
Mailing Address - Country:US
Mailing Address - Phone:317-225-9611
Mailing Address - Fax:
Practice Address - Street 1:5128 E STOP 11 RD STE 34
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-6338
Practice Address - Country:US
Practice Address - Phone:317-721-4169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-14
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28153625A163W00000X, 163WM0102X
IN71013250B363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered Nurse
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn