Provider Demographics
NPI:1255044905
Name:BLURTON, STACEY LEE (NP)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:LEE
Last Name:BLURTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3533 SOUTHERN BLVD STE 3750
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-1268
Mailing Address - Country:US
Mailing Address - Phone:937-610-3220
Mailing Address - Fax:
Practice Address - Street 1:3533 SOUTHERN BLVD STE 3750
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-1268
Practice Address - Country:US
Practice Address - Phone:937-610-3220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-27
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0032827363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily