Provider Demographics
NPI:1750793576
Name:BOND, STACY D (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:D
Last Name:BOND
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1268
Mailing Address - Street 2:
Mailing Address - City:OLIVE HILL
Mailing Address - State:KY
Mailing Address - Zip Code:41164-1268
Mailing Address - Country:US
Mailing Address - Phone:606-286-4152
Mailing Address - Fax:606-286-2385
Practice Address - Street 1:155 BRICKLAYER ST
Practice Address - Street 2:
Practice Address - City:OLIVE HILL
Practice Address - State:KY
Practice Address - Zip Code:41164
Practice Address - Country:US
Practice Address - Phone:606-286-4152
Practice Address - Fax:606-286-2385
Is Sole Proprietor?:No
Enumeration Date:2014-05-28
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3008648363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100332500Medicaid
KY7100332500Medicaid