Provider Demographics
NPI:1487828174
Name:STACKHOUSE, MICHAEL CRAIG II (MPAS, APA-C)
Entity Type:Individual
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First Name:MICHAEL
Middle Name:CRAIG
Last Name:STACKHOUSE
Suffix:II
Gender:M
Credentials:MPAS, APA-C
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Mailing Address - Street 1:WOMACK ARMY MEDICAL CENTER WAMC STOP A
Mailing Address - Street 2:BLDG 4-2817 REILLY ROAD
Mailing Address - City:FORT BRAGG
Mailing Address - State:NC
Mailing Address - Zip Code:28310-0001
Mailing Address - Country:US
Mailing Address - Phone:910-907-7136
Mailing Address - Fax:910-907-6069
Practice Address - Street 1:WOMACK ARMY MEDICAL CENTER WAMC STOP A
Practice Address - Street 2:BLDG 4-2817 REILLY ROAD
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-0001
Practice Address - Country:US
Practice Address - Phone:910-907-7136
Practice Address - Fax:910-907-6069
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-15
Last Update Date:2024-03-30
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant