Provider Demographics
NPI:1659618791
Name:DUBOIS, STACI PESSETTI (PA)
Entity type:Individual
Prefix:MS
First Name:STACI
Middle Name:PESSETTI
Last Name:DUBOIS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:STACI
Other - Middle Name:MARIE
Other - Last Name:PESSETTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5221 PARAMOUNT PKWY STE 220
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-5490
Mailing Address - Country:US
Mailing Address - Phone:984-215-4111
Mailing Address - Fax:
Practice Address - Street 1:34 HEALTHPARK WAY STE 100
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-4497
Practice Address - Country:US
Practice Address - Phone:919-585-8850
Practice Address - Fax:919-585-8869
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2025-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-03966363A00000X
NC03966363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant