Provider Demographics
NPI:1376501601
Name:PIERCE, STACEY L (PA-C)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:L
Last Name:PIERCE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1629 UNION AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:NATRONA HEIGHTS
Mailing Address - State:PA
Mailing Address - Zip Code:15065-2134
Mailing Address - Country:US
Mailing Address - Phone:724-671-1161
Mailing Address - Fax:724-671-1170
Practice Address - Street 1:1629 UNION AVE STE 4
Practice Address - Street 2:
Practice Address - City:NATRONA HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:15065-2134
Practice Address - Country:US
Practice Address - Phone:724-671-1161
Practice Address - Fax:724-671-1170
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA001198L363A00000X
PAOA002426363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
12082426OtherCAQH
PA103192381Medicaid
PA103192381Medicaid