Provider Demographics
NPI:1316978711
Name:SMITH, STACIE LYNN (CRNP)
Entity type:Individual
Prefix:MS
First Name:STACIE
Middle Name:LYNN
Last Name:SMITH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:STACIE
Other - Middle Name:LYNN
Other - Last Name:STERCHO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:233 MCHENRY DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-7826
Mailing Address - Country:US
Mailing Address - Phone:410-404-4987
Mailing Address - Fax:706-850-5721
Practice Address - Street 1:503 N 21ST ST
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-2204
Practice Address - Country:US
Practice Address - Phone:717-763-2181
Practice Address - Fax:717-972-4119
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP008240363LN0005X
MDR073596363LN0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA107615OtherJOHNS HOPKINS
MD533656OtherCAREFIRST MD BCBS
PA1551725OtherGATEWAY-WMG