Provider Demographics
NPI:1366925109
Name:STALNAKER, LACEY LEIGH ANN (FNP)
Entity type:Individual
Prefix:MRS
First Name:LACEY
Middle Name:LEIGH ANN
Last Name:STALNAKER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:LACEY
Other - Middle Name:LEIGH ANN
Other - Last Name:DRIVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1791 ALUM CREEK DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43207-1757
Mailing Address - Country:US
Mailing Address - Phone:614-445-8131
Mailing Address - Fax:
Practice Address - Street 1:1791 ALUM CREEK DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-1757
Practice Address - Country:US
Practice Address - Phone:614-445-8131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.378894163WP0000X
OHAPRN.CNP.023186363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WP0000XNursing Service ProvidersRegistered NursePain Management