Individual
AMY STACEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
502 W SAINT LOUIS ST STE 4, WEST FRANKFORT, IL 62896-1968
(618) 937-3400
(618) 997-9324
Mailing address
502 W SAINT LOUIS ST STE 4, WEST FRANKFORT, IL 62896-1968
(618) 937-3400
(618) 997-9324
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085007306
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
214881
MULTI SPECIALTY GROUP PTAN
IL
Enumeration date
12/24/2019
Last updated
12/24/2019
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