STACIE D DETMER (NPI# 1235380064) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235380064 |
| Entity Type | Individual |
| Full Name | STACIE D DETMER |
| Other Name | STACIE D LANE |
| Credential | FNP |
| Practice Address |
1011 Bowles Ave Ste 450 Fenton MO 63026-0562 |
| Mailing Address |
Po Box 23340 Saint Louis MO 63156-3340 |
| Practice Telephone | 3144671500 |
| Practice Fax Number | 3144671515 |
| Mailing Telephone | 3148511000 |
| Mailing Fax Number | 3148514445 |
| Enumeration Date | 2008-10-10 |
| Last Update Date | 2019-05-21 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
2005018747 | MO | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1011 BOWLES AVE STE 450 |
| City | FENTON |
| State | MO |
| Zip Code | 63026-0562 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871000372 | Allison Egler | Audiologist | 1011 Bowles Ave Ste 405, Fenton, MO 63026 | 2018-01-05 |
| 1629508213 | Holly Brooks Munson | Massage Therapist | 220 Copper Mountain Dr, Fenton, MO 63026 | 2017-06-15 |
| 1073978862 | Naomi Sharon | Nurse Practitioner | 1101 Bowles Avenue, Suite G50, Fenton, MO 63026 | 2015-12-21 |
| 1871981704 | Celtic Private Care of Il & Mo, LLC | In Home Supportive Care | 1653 Larkin Williams Road, Suite 201, Fenton, MO 63026 | 2014-12-30 |
| 1356747513 | Kristina Potts | Nurse Practitioner | 774 Gravois Bluffs Blvd Ste B, Fenton, MO 63026 | 2014-11-14 |
| 1245642420 | Physicians Health Group Medical Inc | General Practice | 960 S. Highway Dr, Fenton, MO 63026 | 2014-05-22 |
| 1598047409 | Kevin Eugene Bruce | Pharmacist | 1210 Sugar Creek, Fenton, MO 63026 | 2011-09-16 |
| 1215186382 | Concentra Health Services, Inc. | Clinic/Center | 128 Matrix Commons Dr., Fenton, MO 63026 | 2008-09-15 |
| 1790954410 | Castlewood Treatment Center LLC | Community/Behavioral Health | 1855 Bowles Ave, Suite 210, Fenton, MO 63026 | 2008-02-27 |
| 1073703617 | Christina R Baeres | Dietitian, Registered | 38 Majestic Ct, Fenton, MO 63026 | 2007-07-30 |
| Find all providers in zip 63026 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215591375 | Katherine Schoo | Nurse Practitioner | 1375 N Highway Dr, Fenton, MO 63026-1929 | 2019-04-24 |
| 1437634904 | Linda Trinh Boucher | Nurse Practitioner | 1011 Bowles Ave Ste 205, Fenton, MO 63026-2387 | 2018-10-01 |
| 1952709099 | Kellie Hopkins | Nurse Practitioner | 1747 Smizer Station Rd Ste 5, Fenton, MO 63026-2784 | 2014-12-05 |
| 1356747513 | Kristina Potts | Nurse Practitioner | 774 Gravois Bluffs Blvd Ste B, Fenton, MO 63026 | 2014-11-14 |
| 1033524665 | Brooke Salas | Nurse Practitioner | 774 Gravois Bluffs Blvd Ste A, Fenton, MO 63026-7758 | 2014-06-23 |
| 1720006844 | Susan James | Nurse Practitioner | 1001 Bowles Ave, Fenton, MO 63026-2338 | 2006-07-17 |
| 1639777162 | Painless Medical Pllc | Nurse Practitioner | 2803 W Silver Lake Rd, Fenton, MI 48430-2655 | 2020-10-16 |
| 1346848215 | Alexandra E Zdenek | Nurse Practitioner | 1100 Torrey Rd Ste 300, Fenton, MI 48430-3327 | 2020-10-13 |
| 1164064440 | Kimberly Michelle Emery | Nurse Practitioner | 1345 Smizer Mill Rd Ste 1100, Fenton, MO 63026-7305 | 2019-10-08 |
| 1003466087 | Michelle M Wojek | Nurse Practitioner | 2803 W Silver Lake Rd, Fenton, MI 48430-2655 | 2019-09-12 |
| Find all providers in FENTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.