Healthcare Provider Details

I. General information

NPI: 1497614903
Provider Name (Legal Business Name): STACIA D HILL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2026
Last Update Date: 01/20/2026
Certification Date: 01/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 N GALILEO DR
NIXA MO
65714-7893
US

IV. Provider business mailing address

625 N GALILEO DR
NIXA MO
65714-7893
US

V. Phone/Fax

Practice location:
  • Phone: 417-861-6717
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2019027233
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: