Provider Demographics
NPI:1841523214
Name:HART-STIFFLER, KERRY ANN (CNP)
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:ANN
Last Name:HART-STIFFLER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:KERRY
Other - Middle Name:ANN
Other - Last Name:HART-HECKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:370 CLINE AVE STE B3
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-1081
Mailing Address - Country:US
Mailing Address - Phone:419-756-9995
Mailing Address - Fax:419-756-1135
Practice Address - Street 1:370 CLINE AVE STE B3
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-1081
Practice Address - Country:US
Practice Address - Phone:419-756-9995
Practice Address - Fax:419-756-1135
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.10985363LA2200X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3000924Medicaid
OH3000924Medicaid