Healthcare Provider Details

I. General information

NPI: 1316585474
Provider Name (Legal Business Name): STACEY ALLEN COYLE CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2019
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 9TH ST
NEW BRIGHTON PA
15066-1928
US

IV. Provider business mailing address

302 9TH ST
NEW BRIGHTON PA
15066-1928
US

V. Phone/Fax

Practice location:
  • Phone: 724-252-8372
  • Fax: 724-252-4327
Mailing address:
  • Phone: 724-252-8372
  • Fax: 724-252-4327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP021454
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: