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General NPI Number Information
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NPI Number | 1346418001
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Entity Type | Individual
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Provider Name | SHERYL ANN STACK APRN
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Gender | Female
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Dates
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Enumeration Date | 02/15/2008
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Last Update Date | 08/12/2024
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Provider Practice Location Address
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Address Line | 610 E BRANNON RD STE 100
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City | NICHOLASVILLE
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State | KY
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Zip | 40356-6065
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Country | US
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Telephone | 859-260-5540
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Fax |
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Provider Business Mailing Address
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Address Line | 5200 COMMERCE CROSSING 3RD FL
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City | LOUISVILLE
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State | KY
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Zip | 40229
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Country | US
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Telephone | 502-861-5278
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Fax | 502-861-5278
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 3005514
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APN0000013260
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License Number State | TN
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