Individual
STACEY LYNN CLANCY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
10345 WATSON RD, ST LOUIS, MO 63127
(314) 965-6033
(314) 965-6067
Mailing address
10345 WATSON RD, ST LOUIS, MO 63127
(314) 965-6033
(314) 965-6067
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
112661
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
95124
MEDICARE NUMBER 95124
MO
Enumeration date
09/03/2006
Last updated
12/11/2019
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