Provider Demographics
NPI:1558592212
Name:LINKOUS, STACI LYN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:STACI
Middle Name:LYN
Last Name:LINKOUS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:STACI
Other - Middle Name:LYN
Other - Last Name:CRAFT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:200 12TH STREET EXTENSION
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-2329
Mailing Address - Country:US
Mailing Address - Phone:304-425-9541
Mailing Address - Fax:304-431-2856
Practice Address - Street 1:200 12TH STREET EXTENSION
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2329
Practice Address - Country:US
Practice Address - Phone:304-425-9541
Practice Address - Fax:304-431-2856
Is Sole Proprietor?:No
Enumeration Date:2009-07-29
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1472363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant