Provider Demographics
NPI:1659729093
Name:REAGAN, STACIA (PA-C, OSTEOPATHIC PA)
Entity Type:Individual
Prefix:MRS
First Name:STACIA
Middle Name:
Last Name:REAGAN
Suffix:
Gender:F
Credentials:PA-C, OSTEOPATHIC PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 E ROWAN AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99207-1214
Mailing Address - Country:US
Mailing Address - Phone:509-487-8000
Mailing Address - Fax:509-487-6333
Practice Address - Street 1:124 E ROWAN AVE STE 101
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-1214
Practice Address - Country:US
Practice Address - Phone:509-487-6222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-26
Last Update Date:2020-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60790383363A00000X
WAOA60801269208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant