Healthcare Provider Details

I. General information

NPI: 1710836614
Provider Name (Legal Business Name): HALO MEDICAL & AESTHETICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2026
Last Update Date: 01/23/2026
Certification Date: 01/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2642 US 52
GILBERT WV
25621
US

IV. Provider business mailing address

2642 US 52
GILBERT WV
25621
US

V. Phone/Fax

Practice location:
  • Phone: 304-784-3649
  • Fax: 304-223-7654
Mailing address:
  • Phone: 304-784-3649
  • Fax: 304-223-7654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: CANDICE STACY
Title or Position: OWNER, FNP-BC
Credential: APRN, FNP-BC
Phone: 304-784-3649