Provider Demographics
NPI:1407959463
Name:STACEY, CHRISTOPHER J (PA-C)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:J
Last Name:STACEY
Suffix:
Gender:M
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 1:2940 SQUALICUM PKWY STE 203
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1892
Mailing Address - Country:US
Mailing Address - Phone:360-738-3223
Mailing Address - Fax:360-733-1034
Practice Address - Street 1:2940 SQUALICUM PKWY
Practice Address - Street 2:#203
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1892
Practice Address - Country:US
Practice Address - Phone:360-733-0640
Practice Address - Fax:360-733-1034
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004130363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8353880Medicaid
WA8353880Medicaid