Provider Demographics
NPI:1861759466
Name:KLINE, STACY DEBRA (LM)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:DEBRA
Last Name:KLINE
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 EDGEWATER BEACH DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-4737
Mailing Address - Country:US
Mailing Address - Phone:863-680-2229
Mailing Address - Fax:863-682-4784
Practice Address - Street 1:1525 EDGEWATER BEACH DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-4737
Practice Address - Country:US
Practice Address - Phone:863-680-2229
Practice Address - Fax:863-682-4784
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW256175M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay