Healthcare Provider Details

I. General information

NPI: 1336929421
Provider Name (Legal Business Name): STACEY HOBBICK DNP, MSN-ED, RN,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STACEY HUTCHISON

II. Dates (important events)

Enumeration Date: 10/05/2023
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2865 DAGGETT AVE
KLAMATH FALLS OR
97601-1106
US

IV. Provider business mailing address

936 S FOREST CREEK DR
SAINT AUGUSTINE FL
32092-0755
US

V. Phone/Fax

Practice location:
  • Phone: 980-328-4403
  • Fax:
Mailing address:
  • Phone: 980-328-4403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95177865
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number10030771
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: