MEDICARE: STACEY L. POEHNER N.P.

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	363L00000X	Nurse Practitioner	4197	KY

Other Identifiers

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

General Provider Information

NPI Number	:	1891811758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY L. POEHNER N.P.

Provider Business Mailing Address
First Line	:	PO BOX 950293
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40295-0293
Country	:	US
Telephone Number	:	888-987-1875
Fax Number	:	405-609-1491

Provider Business Practice Location Address
First Line	:	1707 CEDAR GROVE RD
Second Line	:	SUITE 20
City	:	SHEPHERDSVILLE
State	:	KY
Zip	:	40165-8572
Country	:	US
Telephone Number	:	502-215-2090
Fax Number	:	502-215-5095

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

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	08/24/2016

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