Provider Demographics
NPI:1194438903
Name:KIEFFER, STACEY (RN, CCM, COHN-S)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:KIEFFER
Suffix:
Gender:F
Credentials:RN, CCM, COHN-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 KIEFFER RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:GA
Mailing Address - Zip Code:31329-4435
Mailing Address - Country:US
Mailing Address - Phone:912-663-4826
Mailing Address - Fax:888-838-0381
Practice Address - Street 1:181 KIEFFER RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:GA
Practice Address - Zip Code:31329-4435
Practice Address - Country:US
Practice Address - Phone:912-663-4826
Practice Address - Fax:888-838-0381
Is Sole Proprietor?:No
Enumeration Date:2022-12-27
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN131184163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management