Provider Demographics
NPI:1093743643
Name:KARNS, STACEY L (PA)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:L
Last Name:KARNS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 E MAIN ST
Mailing Address - Street 2:PO BOX 99
Mailing Address - City:STANBERRY
Mailing Address - State:MO
Mailing Address - Zip Code:64489-1358
Mailing Address - Country:US
Mailing Address - Phone:660-783-2192
Mailing Address - Fax:660-783-2616
Practice Address - Street 1:202 E MAIN ST
Practice Address - Street 2:
Practice Address - City:STANBERRY
Practice Address - State:MO
Practice Address - Zip Code:64489-1358
Practice Address - Country:US
Practice Address - Phone:660-783-2192
Practice Address - Fax:660-783-2616
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO113478363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO113478OtherPHYSICIAN ASSISTANT LICEN