Healthcare Provider Details

I. General information

NPI: 1407604614
Provider Name (Legal Business Name): VICTORIA ANNE STUBBLEFIELD PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2024
Last Update Date: 10/16/2026
Certification Date: 10/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 N LIMESTONE ST STE 150
SPRINGFIELD OH
45503-1120
US

IV. Provider business mailing address

2600 N LIMESTONE ST STE 150
SPRINGFIELD OH
45503-1120
US

V. Phone/Fax

Practice location:
  • Phone: 937-523-9850
  • Fax: 937-523-9859
Mailing address:
  • Phone: 937-523-9850
  • Fax: 937-523-9859

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.010567RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: