Healthcare Provider Details

I. General information

NPI: 1457267049
Provider Name (Legal Business Name): STACY LYNN MCCARL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STACY REED LPN/LVN

II. Dates (important events)

Enumeration Date: 08/22/2026
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1966 E LOWELL ST
KLAMATH FALLS OR
97601-1829
US

IV. Provider business mailing address

1966 E LOWELL ST
KLAMATH FALLS OR
97601-1829
US

V. Phone/Fax

Practice location:
  • Phone: 541-851-1017
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number201708734LPN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: