Provider Demographics
NPI:1821581158
Name:SMITH, STACIE JEAN (ARNP)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:JEAN
Last Name:SMITH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 HIOAKS RD
Mailing Address - Street 2:STE B
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4072
Mailing Address - Country:US
Mailing Address - Phone:804-272-5814
Mailing Address - Fax:804-560-0232
Practice Address - Street 1:12100 KAIN RD
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-5717
Practice Address - Country:US
Practice Address - Phone:302-943-8570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024176175363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner