Individual
MRS. STACY ANNETTE CHURCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3100 MACCORKLE AVE SE, SUITE 610, CHARLESTON, WV 25304-1223
(304) 346-1141
(304) 346-1142
Mailing address
3100 MACCORKLE AVE SE, SUITE 610, CHARLESTON, WV 25304-1223
(304) 346-1141
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
01163
WV
Other
Enumeration date
08/15/2006
Last updated
06/21/2011
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