MEDICARE: STACEY HISER ARNP

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
1	363LF0000X	Family Nurse Practitioner	3005366	KY
2	163W00000X	Registered Nurse	1103814	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000656939	OTHER		ANTHEM BC & BS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1235323338	OTHER	KY	NPI

General Provider Information

NPI Number	:	1235323338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY HISER ARNP

Provider Business Mailing Address
First Line	:	4600 MONTOGMERY RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45212
Country	:	US
Telephone Number	:	833-510-4357
Fax Number	:	866-460-2997

Provider Business Practice Location Address
First Line	:	621 HAPPY VALLEY RD
Second Line	:
City	:	GLASGOW
State	:	KY
Zip	:	42141-2416
Country	:	US
Telephone Number	:	833-510-4357
Fax Number	:	866-460-2997

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2007
Last Update Date	:	05/23/2024

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