Individual
KACY MARIE STANDIFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1120 N MELVIN ST, GIBSON CITY, IL 60936-1477
(217) 784-4251
Mailing address
1120 N MELVIN ST, GIBSON CITY, IL 60936-1477
(217) 784-4251
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
085007378
IL
363A00000X
Physician Assistant
Primary
085007378
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
370647938
MOLINA NUMBER
IL
Enumeration date
10/18/2019
Last updated
02/13/2026
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