Provider Demographics
NPI:1497226252
Name:STANCIL, KACIE B (NP)
Entity Type:Individual
Prefix:
First Name:KACIE
Middle Name:B
Last Name:STANCIL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-5612
Mailing Address - Country:US
Mailing Address - Phone:336-625-8410
Mailing Address - Fax:
Practice Address - Street 1:1007 N 6TH ST
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-3551
Practice Address - Country:US
Practice Address - Phone:704-982-8410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5011264363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily