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NPI Code Detail

MEDICARE: STACY DEBRA KLINE LM

MEDICARE: STACY DEBRA KLINE LM
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
1175M00000XLay MidwifeMW256FL

General Provider Information

NPI Number : 1861759466
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACY DEBRA KLINE LM
Provider Business Mailing Address
First Line : 1525 EDGEWATER BEACH DR
Second Line :
City : LAKELAND
State : FL
Zip : 33805-4737
Country : US
Telephone Number : 863-680-2229
Fax Number : 863-682-4784
Provider Business Practice Location Address
First Line : 1525 EDGEWATER BEACH DR
Second Line :
City : LAKELAND
State : FL
Zip : 33805-4737
Country : US
Telephone Number : 863-680-2229
Fax Number : 863-682-4784
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2012
Last Update Date : 04/19/2012

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Directions to “ STACY DEBRA KLINE LM” Practice Location

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