Provider Demographics
NPI:1609530641
Name:BRIGGS, STACIE (PA-C)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:
Last Name:BRIGGS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:STACIE
Other - Middle Name:
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 N CALEDONIA DR
Mailing Address - Street 2:
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-8844
Mailing Address - Country:US
Mailing Address - Phone:989-729-4848
Mailing Address - Fax:989-729-4849
Practice Address - Street 1:200 N CALEDONIA DR
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-8844
Practice Address - Country:US
Practice Address - Phone:989-729-4848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601010727363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant