MEDICARE: STACY GLOVER

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	172A00000X	Driver

General Provider Information

NPI Number	:	1275247645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACY GLOVER

Provider Business Mailing Address
First Line	:	211 WESTRIDGE DR APT B
Second Line	:
City	:	WEST MONROE
State	:	LA
Zip	:	71291-9045
Country	:	US
Telephone Number	:	318-235-3489
Fax Number	:

Provider Business Practice Location Address
First Line	:	211 WESTRIDGE DR APT B
Second Line	:
City	:	WEST MONROE
State	:	LA
Zip	:	71291-9045
Country	:	US
Telephone Number	:	318-235-3489
Fax Number	:

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

Provider Enumeration Date	:	01/10/2023
Last Update Date	:	01/10/2023

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Directions to “ STACY GLOVER ” Practice Location

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