STACEY B. FAZENBAKER (NPI# 1487615787) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487615787 |
| Entity Type | Individual |
| Full Name | STACEY B. FAZENBAKER |
| Credential | M. D. |
| Practice Address |
240 Ayer Pkwy E Madisonville KY 42431-8999 |
| Practice Telephone | 2708258345 |
| Practice Fax Number | 2708252975 |
| Mailing Telephone | 2708258345 |
| Mailing Fax Number | 2708252975 |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2019-05-14 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 35999 | KY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KY | 6402415100 | 05 | |
| KY | ANTHEM | 000000811728 | 01 |
| KY | COMMONWEALTH BIOMEDICAL RESEARCH GROUP PTAN | 7570 | 01 |
| KY | KY MEDICAL LICENSE NUMBER | 35999 | 01 |
| Street Address |
240 AYER PKWY E |
| City | MADISONVILLE |
| State | KY |
| Zip Code | 42431-8999 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982737961 | Commonwealth Biomedical Research LLC | Acupuncturist | 240 Ayer Pkwy E, Madisonville, KY 42431-8999 | 2007-03-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750846309 | Sarah Davenport Ziegler | Registered Nurse | 3050 Nebo Rd, Madisonville, KY 42431 | 2019-02-08 |
| 1134604903 | Kelsey Dawn Wilson | Occupational Therapist | 425 Island Ford Rd, Madisonville, KY 42431 | 2018-09-27 |
| 1174006209 | Shaun Vickery | Physical Therapist | 425 Island Ford Road, Madisonville, KY 42431 | 2018-09-14 |
| 1881115384 | Filza Tajik | Speech-Language Pathologist | 1305-1 W. Noel Ave, Unit 1, Madisonville, KY 42431 | 2017-07-05 |
| 1245769280 | Susan Hart | Student in an Organized Health Care Education/Training Program | 200 Clinic Drive, Third North, Madisonville, KY 42431 | 2017-06-05 |
| 1811363880 | Cory Eakins | Nutritionist | 2223 S Main St, Madisonville, KY 42431 | 2015-08-13 |
| 1932598257 | Deidra Boyken | Counselor | 145 E. Center Street Suite 1d, Madisonville, KY 42431 | 2015-01-12 |
| 1841602398 | Jessica France | Occupational Therapist | 339 S Seminary St, Madisonville, KY 42431 | 2014-06-02 |
| 1497097562 | Sunrise Children's Services | Community/Behavioral Health | 1079 Thornberry Dr Ste 203, Madisonville, KY 42431 | 2013-03-26 |
| 1013275023 | Creasha King | Counselor | 1079 Thornberry Dr Ste B, Madisonville, KY 42431 | 2012-04-26 |
| Find all providers in zip 42431 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952723165 | S&t Beverley, LLC | Family Medicine | 321 Tellico St S, Madisonville, TN 37354-1194 | 2014-01-08 |
| 1285955443 | Madisonville Medical Corp. | Family Medicine | 216 Hwy 21, Madisonville, LA 70447 | 2010-06-22 |
| 1457510646 | Sheila Ann Maddox | Family Medicine | 402 Saint Tammany St, Madisonville, LA 70447-9713 | 2008-06-03 |
| 1760660765 | John Haastrup | Family Medicine | 912 N Kentucky Ave # A16, Madisonville, KY 42431-1663 | 2008-02-01 |
| 1720197437 | Grover Cleveland Hubley Jr. | Family Medicine | 813 South State Street Suite 100, Madisonville, TX 77864 | 2006-08-29 |
| 1508803370 | Family Practice Associates, PC | Family Medicine | 4233 Highway 411, Madisonville, TN 37354-1571 | 2006-06-01 |
| 1083651533 | Tracey D Beverley | Family Medicine | 321 Tellico Street, Madisonville, TN 37354-1194 | 2006-06-01 |
| 1952354524 | Horizon Clinic LLC | Family Medicine | 435 N Kentucky Ave, Madisonville, KY 42431-1768 | 2006-05-18 |
| 1114988094 | Mary Helen Morrow | Family Medicine | 604 S Madison St, Madisonville, TX 77864-1956 | 2006-03-30 |
| 1306813431 | Diana M. Stulc, Psc | Family Medicine | 444 S Main St, Madisonville, KY 42431-2871 | 2006-03-08 |
| Find all providers in MADISONVILLE | ||||
| City | MADISONVILLE |
| Zip Code | 42431 |
Please comment or provide details below to improve the information on STACEY B. FAZENBAKER.
| 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.