Provider Demographics
NPI:1700521242
Name:NOBLES, STACEY (PR)
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:
Last Name:NOBLES
Suffix:
Gender:F
Credentials:PR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419 12TH ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-2212
Mailing Address - Country:US
Mailing Address - Phone:681-888-5291
Mailing Address - Fax:
Practice Address - Street 1:419 12TH ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-2212
Practice Address - Country:US
Practice Address - Phone:681-888-5291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-29
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175T00000XOther Service ProvidersPeer SpecialistGroup - Single Specialty