Provider Demographics
NPI:1578826681
Name:SUTTLES, STACEY TILLMAN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:TILLMAN
Last Name:SUTTLES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:USARMY HEALTH CLINICS SCHOFIELD BARRACKS
Mailing Address - Street 2:BLD 683, ATTN: FNS BLD 681, RM 126
Mailing Address - City:SCHOFIELD BARRACKS
Mailing Address - State:HI
Mailing Address - Zip Code:96857
Mailing Address - Country:US
Mailing Address - Phone:808-433-8475
Mailing Address - Fax:
Practice Address - Street 1:BLD 681, 1ST FLOOR
Practice Address - Street 2:
Practice Address - City:SCHOFIELD BARRACKS
Practice Address - State:HI
Practice Address - Zip Code:96857
Practice Address - Country:US
Practice Address - Phone:808-433-8475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-22
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant