Provider Demographics
NPI:1053411686
Name:COWARD, STACY DENISE (RN)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:DENISE
Last Name:COWARD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1924 STILLMEADOW CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-4940
Mailing Address - Country:US
Mailing Address - Phone:321-287-4927
Mailing Address - Fax:
Practice Address - Street 1:1924 STILLMEADOW CT
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456-4940
Practice Address - Country:US
Practice Address - Phone:321-287-4927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9231733163WP0808X
VARN1169953163WP0808X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VARN1169953OtherREGISTERED NURSE LICENSE
FLRN9231733OtherREGISTERED NURSE LICENSE