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Individual

KATIE MELISSA STANFORD

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MSN, PMHNP-BC

Contact information

Practice address
217 COLUMBUS RD STE 105, ATHENS, OH 45701-1393
(740) 200-0562
(949) 757-6694
Mailing address
217 COLUMBUS RD STE 105, ATHENS, OH 45701-1393
(740) 200-0562
(949) 757-6694

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
2018090842
OH
364SP0809X
Adult Psychiatric/Mental Health Clinical Nurse Specialist
Primary
APRN.CNP.024676
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2018090842
STATE OF OHIO NURSING LICENSE #
OH
Enumeration date
05/29/2019
Last updated
07/17/2024
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