Individual ProviderStacey NalleyNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address215 Central Ave, Louisville, KY 40208-1449(502) 852-6479PECOS EnrollmentBased on the most recent information from CMS, provider Stacey Nalley is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1407269830Provider TypeIndividualFull NameNalley, StaceyCredentialAPRNGenderFemaleSole ProprietorNoEnumeration Date6/3/2014Last Updated2/2/2022Contact InformationPractice LocationPractice Address215 Central Ave, Louisville, KY 40208-1449Phone(502) 852-6479FaxUnlisted FaxMailing LocationMailing AddressPO Box 909, Louisville, KY 40201-0909PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense3008659KentuckyCode363LF0000XDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense28174694AIndianaProvider IdentifiersIDDescriptionIssuerID7100534800DescriptionMedicaidIssuerUnlistedKentucky