Healthcare Provider Details

I. General information

NPI: 1326918962
Provider Name (Legal Business Name): TAWANA MARIE STOCKTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2025
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 PIKE ST
SIDNEY OH
45365-1349
US

IV. Provider business mailing address

753 COUNTRY SIDE LN
SIDNEY OH
45365-5212
US

V. Phone/Fax

Practice location:
  • Phone: 937-507-5452
  • Fax:
Mailing address:
  • Phone: 937-507-5452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: