Individual
MRS. STACEY SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3200 MACCORKLE AVE SE, CHARLESTON, WV 25304-1227
(304) 388-5432
Mailing address
3200 MACCORKLE SEAVE B16, CHARLESTON, WV 25304-1227
(304) 388-1724
(304) 388-1721
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
07/01/2014
Last updated
04/10/2018
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