Provider Demographics
NPI:1083165666
Name:SHEARIN, STACEY KATRINA (CNM)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:KATRINA
Last Name:SHEARIN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:KATRINA
Other - Last Name:HUNT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:NMRTC PORTSMOUTH
Mailing Address - Street 2:620 JOHN PAUL JONES CIRCLE
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23708
Mailing Address - Country:US
Mailing Address - Phone:757-953-4300
Mailing Address - Fax:757-953-9035
Practice Address - Street 1:620 JOHN PAUL JONES CIR
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23708-2111
Practice Address - Country:US
Practice Address - Phone:757-953-4300
Practice Address - Fax:757-466-9262
Is Sole Proprietor?:No
Enumeration Date:2016-10-19
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174113367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife