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Individual
STACEY L PIERCE
Active
Individual
STACEY L PIERCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
MA001198L
PA
363A00000X
Physician Assistant
Primary
OA002426
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103192381
—
PA
01
—
12082426
CAQH
—
Enumeration date
05/03/2006
Last updated
10/06/2020
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