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General NPI Number Information
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NPI Number | 1043063860
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Entity Type | Individual
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Provider Name | STACEY MARIE CLIFTON FNP
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Gender | Female
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Dates
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Enumeration Date | 04/10/2024
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Last Update Date | 04/18/2024
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Provider Practice Location Address
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Address Line | 10388 GA HIGHWAY 23 N
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City | METTER
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State | GA
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Zip | 30439-8564
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Country | US
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Telephone | 912-687-4660
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Fax |
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Provider Business Mailing Address
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Address Line | 10388 GA HIGHWAY 23 N
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City | METTER
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State | GA
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Zip | 30439-8564
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Country | US
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Telephone | 912-687-4660
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN238211
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License Number State | GA
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