Provider Demographics
NPI:1609670546
Name:STACE, KEARA
Entity type:Individual
Prefix:
First Name:KEARA
Middle Name:
Last Name:STACE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7875 BURR OAK NEW HOPE RD
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:OH
Mailing Address - Zip Code:45326-8769
Mailing Address - Country:US
Mailing Address - Phone:937-214-2304
Mailing Address - Fax:
Practice Address - Street 1:7875 BURR OAK NEW HOPE RD
Practice Address - Street 2:
Practice Address - City:FLETCHER
Practice Address - State:OH
Practice Address - Zip Code:45326-8769
Practice Address - Country:US
Practice Address - Phone:937-214-2304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No347C00000XTransportation ServicesPrivate Vehicle