Healthcare Provider Details

I. General information

NPI: 1225891088
Provider Name (Legal Business Name): STEPHANIE COON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2024
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6888 GROUT BROOK RD
HOMER NY
13077-8707
US

IV. Provider business mailing address

6888 GROUT BROOK RD
HOMER NY
13077-8707
US

V. Phone/Fax

Practice location:
  • Phone: 607-749-0795
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF351855-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: