STACEY LYNN KELLER (NPI# 1831441831) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1831441831 |
| Entity Type | Individual |
| Full Name | STACEY LYNN KELLER |
| Credential | PA-C |
| Practice Address |
4466 Fulton Dr Nw Canton OH 44718-2864 |
| Mailing Address |
168 E Market St Po Box 3542 Akron OH 44308-2038 |
| Practice Telephone | 3304891386 |
| Practice Fax Number | 3304891258 |
| Mailing Telephone | 3309960347 |
| Mailing Fax Number | 3309960359 |
| Enumeration Date | 2012-10-15 |
| Last Update Date | 2013-06-18 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 50-003643 | OH | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316590144 | Stacey Marlene Keller | Social Worker | 4400 Ne Halsey St, Portland, OR 97213-1545 | 2019-07-21 |
| 1275942567 | Stacey Ann Keller | Physical Therapist | 1512 W Service Dr, Winona, MN 55987-2540 | 2014-08-12 |
| 1205116787 | Stacey Lynn Keller | Pharmacist | 1108 Hartman Ln, Belleville, IL 62221-7921 | 2011-08-28 |
| 1720276306 | Stacey M Keller | Case Manager/Care Coordinator | 2707 Browns Ln, Jonesboro, AR 72401-7213 | 2007-10-09 |
| Street Address |
4466 FULTON DR NW |
| City | CANTON |
| State | OH |
| Zip Code | 44718-2864 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780623645 | Firas M.a. Hamdan | Internal Medicine | 4466 Fulton Dr Nw, Canton, OH 44718-2864 | 2006-06-06 |
| 1609427004 | Mary Peterson | Physician Assistant | 4466 Fulton Dr Nw, Canton, OH 44718-2864 | 2019-09-26 |
| 1366002321 | Crystal Clinic Orthopaedic Center, LLC | Special Hospital | 4466 Fulton Dr Nw, Canton, OH 44718-2864 | 2019-06-20 |
| 1568873446 | Jordan Etscheidt | Orthopaedic Surgery | 4466 Fulton Dr Nw, Canton, OH 44718-2864 | 2014-05-14 |
| 1962792515 | Shayda Mirhaidari | Plastic Surgery | 4466 Fulton Dr Nw, Canton, OH 44718-2864 | 2011-04-17 |
| 1922288778 | Rebecca L. Wolfe | Physician Assistant | 4466 Fulton Dr Nw, Canton, OH 44718-2864 | 2007-11-09 |
| 1114026226 | Cardiology One, Inc | Internal Medicine | 4466 Fulton Dr Nw, Canton, OH 44718-2864 | 2006-09-22 |
| 1578585956 | Tiffany M. Fisher | Physician Assistant | 4466 Fulton Dr Nw, Canton, OH 44718-2864 | 2006-07-24 |
| 1003850710 | Todd L Johnson | Internal Medicine | 4466 Fulton Dr Nw, Canton, OH 44718-2864 | 2006-06-15 |
| 1851334973 | Brian E Simmons | Internal Medicine | 4466 Fulton Dr Nw, Canton, OH 44718-2864 | 2006-06-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639658057 | Christine Lynn Mccrone | Psychologist | 4450 Belden Village St Nw Ste 701, Canton, OH 44718 | 2018-08-07 |
| 1295252500 | Dora C Holliday | Student in an Organized Health Care Education/Training Program | 4641 Fulton Dr N.w., Canton, OH 44718 | 2017-08-28 |
| 1770035487 | A B A Let's Play, Inc. | Community/Behavioral Health | 6304 Shipslanding Ave Nw, Canton, OH 44718 | 2016-10-28 |
| 1457710139 | Aria Lg Counseling and Wellness Center, LLC | Clinic/Center | 5262 Fulton Road Nw, Canton, OH 44718 | 2016-02-23 |
| 1457722365 | Melinda R Bond | Nurse Practitioner | 4105 Holiday Street Nw, Canton, OH 44718 | 2015-10-19 |
| 1164804860 | Ashley Marie Whetsell | Dentist | 4550 Belden Village Street Nw, Canton, OH 44718 | 2015-06-18 |
| 1346643749 | Emil D. Poporad, Dds | Dentist | 4124 Fulton Rd. N.w., Suite 102, Canton, OH 44718 | 2014-09-30 |
| 1699198390 | Lauri Sanders | Social Worker | 5860 Fulton Dr Nw, Canton, OH 44718 | 2014-01-31 |
| 1376893768 | Courteney R Briceland | Social Worker | 4641 Fulton Rd. Nw, Canton, OH 44718 | 2012-09-13 |
| 1982953220 | Lyudmyla Z Rockaway | Marriage & Family Therapist | 4895 Dressler Road Nw, Ste A, Canton, OH 44718 | 2012-08-31 |
| Find all providers in zip 44718 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164048674 | Rebecca Lynn Yunk | Physician Assistant | 50433 Monroe St, Canton, MI 48188-6601 | 2020-06-20 |
| 1780210781 | Olivia Anastasia Basso | Physician Assistant | 4912 Higbee Ave Nw Ste 200, Canton, OH 44718-2599 | 2020-03-21 |
| 1700428802 | Meagan Elizabeth Hogan | Physician Assistant | 6119 Us Highway Route 11, Canton, NY 13617 | 2019-10-10 |
| 1578113593 | Luiza Lica | Physician Assistant | 246 Princess Dr, Canton, MI 48188-1142 | 2019-09-12 |
| 1235614900 | Eva Louisa Paoloni | Physician Assistant | 1105 W Maple St Apt 3, Canton, OH 44720-2869 | 2018-09-28 |
| 1992281653 | Elizabeth Judy | Physician Assistant | 460 Northside Cherokee Blvd Ste 430, Canton, GA 30115-8020 | 2018-07-16 |
| 1083124051 | Stephanie Black | Physician Assistant | 1455 Harrison Ave Nw Ste 105, Canton, OH 44708-2609 | 2017-10-04 |
| 1972024594 | Patrick James Sullivan | Physician Assistant | 6619 State Highway Route 11, Canton, NY 13617 | 2017-07-05 |
| 1588111074 | Kinjal Shah | Physician Assistant | 43767 Ford Rd, Canton, MI 48187-3185 | 2016-09-01 |
| 1144683731 | Ellen Catherine Mitchell | Physician Assistant | 48575 Joy Rd, Canton, MI 48187-1214 | 2016-03-31 |
| Find all providers in CANTON | ||||
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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.