Provider Demographics
NPI:1912318791
Name:ELMES, STACEY CHARLOTTE (BA)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:CHARLOTTE
Last Name:ELMES
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2338 ALEXANDER AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217-2405
Mailing Address - Country:US
Mailing Address - Phone:502-432-5791
Mailing Address - Fax:502-742-6398
Practice Address - Street 1:2338 ALEXANDERAVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217
Practice Address - Country:US
Practice Address - Phone:502-432-5791
Practice Address - Fax:502-742-6398
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator