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NPI Code Detail

MEDICARE: MS. STACEY LEVISON FNP-C

MEDICARE: MS. STACEY LEVISON FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerRN160089GA
2207RN0300XNephrology PhysicianRN160089GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1033275946
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. STACEY LEVISON FNP-C
Provider Business Mailing Address
First Line : 2782 COBB PKWY NW
Second Line :
City : KENNESAW
State : GA
Zip : 30152-3472
Country : US
Telephone Number : 770-590-8181
Fax Number :
Provider Business Practice Location Address
First Line : 2782 COBB PKWY NW
Second Line :
City : KENNESAW
State : GA
Zip : 30152-3472
Country : US
Telephone Number : 770-590-8181
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/28/2006
Last Update Date : 10/27/2022

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