Provider Demographics
NPI:1346870268
Name:BASCUE, STACCEY (NP)
Entity Type:Individual
Prefix:
First Name:STACCEY
Middle Name:
Last Name:BASCUE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 FRANKLIN SQUARE WAY STE A
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29642-3715
Mailing Address - Country:US
Mailing Address - Phone:864-442-4110
Mailing Address - Fax:864-442-4126
Practice Address - Street 1:105 FRANKLIN SQUARE WAY STE A
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29642-3715
Practice Address - Country:US
Practice Address - Phone:864-442-4110
Practice Address - Fax:855-206-2136
Is Sole Proprietor?:No
Enumeration Date:2020-01-20
Last Update Date:2022-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23273363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner