Healthcare Provider Details

I. General information

NPI: 1396676474
Provider Name (Legal Business Name): DARNELL STOVALL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 WERTZ AVE NW
CANTON OH
44708-4171
US

IV. Provider business mailing address

131 WERTZ AVE NW
CANTON OH
44708-4171
US

V. Phone/Fax

Practice location:
  • Phone: 234-214-8470
  • Fax:
Mailing address:
  • Phone: 234-214-8471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberPRS.007924
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: