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General NPI Number Information
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NPI Number | 1083112304
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Entity Type | Individual
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Provider Name | STACIE KOONTZ FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 02/01/2018
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Last Update Date | 09/19/2022
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Provider Practice Location Address
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Address Line | 2101 JACOB ST STE 502
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City | WHEELING
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State | WV
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Zip | 26003-3800
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Country | US
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Telephone | 304-234-8476
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Fax |
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Provider Business Mailing Address
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Address Line | 4551 FAIRMONT PIKE RD
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City | WHEELING
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State | WV
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Zip | 26003-7615
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Country | US
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Telephone | 304-233-2625
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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 | APRN68719
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License Number State | WV
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