Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mr. Stacy Wayne Jefferson, LPN-IV

Individual provider Licensed Practical Nurse · NPI 1861645574

Mr. Stacy Wayne Jefferson, LPN-IV is a Licensed Practical Nurse in Georgetown, Ohio. Practices as a sole proprietor. Licensed in Ohio.

Licensed in
OH
In the registry since
2008

Practice location Address checks out

432 N Green St
Georgetown, OH 45121-1011
Phone: (937) 213-0588
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Licensed Practical Nurse (primary) Taxonomy 164W00000X · Licence PN127734 IV (OH)

Record details

NPI number1861645574
Entity typeIndividual (Type 1)
GenderMale
Credentials LPN-IV
Sole proprietorYes
NPI enumeratedOctober 25, 2008
Last updated in NPPESOctober 25, 2008

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