Individual
STACY LYNN DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
5900 E UNIVERSITY AVE, SUITE 200, PLEASANT HILL, IA 50327-8457
(515) 643-2400
(515) 643-4766
Mailing address
PO BOX 1475, DES MOINES, IA 50305-1475
(515) 643-4374
(515) 643-2784
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
001607
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001607
IOWA LICENSE
IA
01
—
71945
WELLMARK BLUE SHIELD
IA
Enumeration date
05/14/2007
Last updated
07/18/2008
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