Basic Information
| Provider Information | |||||||||
| NPI: | 1770954745 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GERACI | ||||||||
| FirstName: | STEPHANIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 128 SUGAR MAPLE DR | ||||||||
| Address2: | |||||||||
| City: | AUBURN | ||||||||
| State: | KY | ||||||||
| PostalCode: | 422065352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2705425500 | ||||||||
| FaxNumber: | 2705425502 | ||||||||
| Practice Location | |||||||||
| Address1: | 223 BURLEY AVE | ||||||||
| Address2: | |||||||||
| City: | HOPKINSVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 422408725 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2708876565 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2015 | ||||||||
| LastUpdateDate: | 08/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 3009713 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.