Provider Demographics
NPI:1265740872
Name:LLOYD, STACEY LYNN (APRN-CNP)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:LYNN
Last Name:LLOYD
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:L
Other - Last Name:KINGERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-366-7500
Mailing Address - Fax:614-366-7560
Practice Address - Street 1:2050 KENNY RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-3502
Practice Address - Country:US
Practice Address - Phone:614-366-7500
Practice Address - Fax:614-366-7560
Is Sole Proprietor?:No
Enumeration Date:2010-09-16
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.11723363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3107300Medicaid
OHH028340Medicare PIN