Individual
MARIAH STACY GANN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
525 N KEENE ST STE 301, COLUMBIA, MO 65201-8106
(573) 449-2141
(573) 556-1750
Mailing address
1241 W STADIUM BLVD, JEFFERSON CITY, MO 65109-6023
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/27/2023
Last updated
08/20/2025
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