Healthcare Provider Details

I. General information

NPI: 1194438903
Provider Name (Legal Business Name): STACEY KIEFFER RN, CCM, COHN-S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2022
Last Update Date: 12/27/2022
Certification Date: 12/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 KIEFFER RD
SPRINGFIELD GA
31329-4435
US

IV. Provider business mailing address

181 KIEFFER RD
SPRINGFIELD GA
31329-4435
US

V. Phone/Fax

Practice location:
  • Phone: 912-663-4826
  • Fax: 888-838-0381
Mailing address:
  • Phone: 912-663-4826
  • Fax: 888-838-0381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN131184
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: