Provider Demographics
NPI:1477919074
Name:OWEN, STACI (PA)
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:
Last Name:OWEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1225 E WEISGARBER RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-2604
Mailing Address - Country:US
Mailing Address - Phone:865-584-4747
Mailing Address - Fax:865-584-1363
Practice Address - Street 1:701 MORGANTON SQUARE DR
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37801-4796
Practice Address - Country:US
Practice Address - Phone:865-984-6823
Practice Address - Fax:865-984-0824
Is Sole Proprietor?:No
Enumeration Date:2016-01-12
Last Update Date:2018-12-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN2948363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant