Provider Demographics
NPI:1710337126
Name:BACON, STARCEY MEGAN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:STARCEY
Middle Name:MEGAN
Last Name:BACON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:STARCEY
Other - Middle Name:MEGAN
Other - Last Name:CARE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:211 INDIAN LAKE BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-6214
Mailing Address - Country:US
Mailing Address - Phone:615-826-3142
Mailing Address - Fax:
Practice Address - Street 1:211 INDIAN LAKE BLVD STE C
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-6214
Practice Address - Country:US
Practice Address - Phone:615-826-3142
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2982363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant