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Individual

STACEY EARNEST

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
806 NW 6TH ST, GRANTS PASS, OR 97526
(541) 955-9227
(541) 734-2410
Mailing address
806 NW 6TH ST, GRANTS PASS, OR 97526-1525
(541) 955-9227
(541) 734-2410

Taxonomy

Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
175T00000X
Peer Specialist
Primary

Other

Enumeration date
03/28/2016
Last updated
08/09/2018
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