Healthcare Provider Details

I. General information

NPI: 1568043180
Provider Name (Legal Business Name): JAMELIA SHEREE STONER CNA/PROGRAM MANAGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 04/15/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 VIEUX CARRE DR
LOUISVILLE KY
40223-3211
US

IV. Provider business mailing address

4147 SUNSET AVE
LOUISVILLE KY
40211-2559
US

V. Phone/Fax

Practice location:
  • Phone: 702-273-7228
  • Fax:
Mailing address:
  • Phone: 702-273-7228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number50115182
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: