Basic Information
Provider Information
NPI: 1508228412
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: STONE
FirstName: JOHN
MiddleName: PAUL
NamePrefix: MR.
NameSuffix:  
Credential: NURSE PRACTITIONER
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 90 JACKSON PIKE
Address2:  
City: GALLIPOLIS
State: OH
PostalCode: 456311560
CountryCode: US
TelephoneNumber: 7404411949
FaxNumber: 7404465982
Practice Location
Address1: 100 JACKSON PIKE
Address2:  
City: GALLIPOLIS
State: OH
PostalCode: 456311560
CountryCode: US
TelephoneNumber: 8554465937
FaxNumber: 7404465532
Other Information
ProviderEnumerationDate: 03/22/2016
LastUpdateDate: 12/29/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/29/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X3009980KYN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
363LF0000XAPRN34512NPWVN Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
363LF0000XCOA.18838-NPOHY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


Home