Provider Demographics
NPI:1114724739
Name:STOVALL, BARBARA
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:STOVALL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 GEORGETOWN RD NE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44704-2326
Mailing Address - Country:US
Mailing Address - Phone:330-232-1527
Mailing Address - Fax:
Practice Address - Street 1:2420 GEORGETOWN RD NE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44704-2326
Practice Address - Country:US
Practice Address - Phone:330-232-1527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-01
Last Update Date:2025-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH129956164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty