Provider Demographics
NPI:1669158754
Name:KELIHER, STACEY (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:KELIHER
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-9509
Mailing Address - Country:US
Mailing Address - Phone:859-619-4633
Mailing Address - Fax:
Practice Address - Street 1:120 PROSPEROUS PL STE 201
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1866
Practice Address - Country:US
Practice Address - Phone:859-368-0609
Practice Address - Fax:859-368-9767
Is Sole Proprietor?:No
Enumeration Date:2023-06-23
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4006284363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health