Basic Information
| Provider Information | |||||||||
| NPI: | 1164625190 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNS | ||||||||
| FirstName: | STACIE | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 151 WEST LAKE STREET | ||||||||
| Address2: | SUITE 1500 | ||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805244124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702378200 | ||||||||
| FaxNumber: | 9702378291 | ||||||||
| Practice Location | |||||||||
| Address1: | 151 W LAKE ST STE 1500 | ||||||||
| Address2: | |||||||||
| City: | FORT COLLINS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805244124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702378200 | ||||||||
| FaxNumber: | 9702378291 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/07/2007 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 46035 | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.