Provider Demographics
NPI:1770869547
Name:MOHLER, STACEY L (CPNP)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:L
Last Name:MOHLER
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:L
Other - Last Name:BAUGHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1671 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-1345
Mailing Address - Country:US
Mailing Address - Phone:740-522-5437
Mailing Address - Fax:740-522-9609
Practice Address - Street 1:1671 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1345
Practice Address - Country:US
Practice Address - Phone:740-522-5437
Practice Address - Fax:740-522-9609
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.12838363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0058821Medicaid