=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801413919
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STACEY WARD FNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2020
-----------------------------------------------------
Last Update Date | 07/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7575 PARAGON RD
-----------------------------------------------------
City | DAYTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45459-5316
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 937-684-2802
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1055 SUMMIT DR.
-----------------------------------------------------
City | MIDDLETOWN
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-420-4678
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | APRN.CNP.0027173
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------