| Doctor Name: | STACY LYNN FENNELL |
| NPI Number: | 1477846582 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | D.O. |
| License Number: | 02004134A |
| Business Practice Address: | 3851 Roger Brooke Dr Mche-emr Fort Sam Houston, TX - 782344501 |
| Business Phone Number: | 2102927626 |
| Business Fax Number: | |
| Mailing Address: | 8344 Versailles Se Rd, BRADFORD |
| State: | OH |
| Postal Code: | 453089602 |
| Phone Number: | 9379748352 |
| Fax Number: | |
| NPI Enumeration Date: | 05/23/2011 |
| NPI Last Update Date: | 05/23/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 02004134A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |