Provider Demographics
NPI:1487652699
Name:STALCUP, STACI KERR (MD)
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:KERR
Last Name:STALCUP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 440014
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37244-0014
Mailing Address - Country:US
Mailing Address - Phone:865-670-6199
Mailing Address - Fax:865-670-6198
Practice Address - Street 1:11606 CHAPMAN HWY
Practice Address - Street 2:STE 2
Practice Address - City:SEYMOUR
Practice Address - State:TN
Practice Address - Zip Code:37865-5270
Practice Address - Country:US
Practice Address - Phone:865-609-6980
Practice Address - Fax:865-609-6982
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2013-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD38363207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN33277201Medicaid
TNI25500Medicare UPIN
TN33277201Medicare PIN