Individual
STACI BHALODI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
360 AMSDEN AVE STE 401, VERSAILLES, KY 40383-1854
(859) 879-2384
(859) 879-2388
Mailing address
360 AMSDEN AVE STE 401, VERSAILLES, KY 40383-1854
(859) 879-2384
(859) 879-2388
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA2120
KY
363AM0700X
Medical Physician Assistant
PA2120
KY
363AS0400X
Surgical Physician Assistant
PA2120
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA2120
LICENSE
KY
Enumeration date
06/17/2012
Last updated
05/13/2025
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