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NPI Code Detail

MEDICARE: STACY ANDERSON

MEDICARE: STACY ANDERSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1252Y00000XEarly Intervention Provider Agency

General Provider Information

NPI Number : 1609604768
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACY ANDERSON
Provider Business Mailing Address
First Line : 1411 N WALKER ST
Second Line :
City : PRINCETON
State : WV
Zip : 24740-2636
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1411 N WALKER ST
Second Line :
City : PRINCETON
State : WV
Zip : 24740-2636
Country : US
Telephone Number : 304-425-2926
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2024
Last Update Date : 07/22/2024

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Directions to “ STACY ANDERSON ” Practice Location

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