Provider Demographics
NPI:1851340038
Name:LUNA, STACY MARIE (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:STACY
Middle Name:MARIE
Last Name:LUNA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:MARIE
Other - Last Name:KISSEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1041 KIRKPATRICK RD STE 150
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-8068
Mailing Address - Country:US
Mailing Address - Phone:336-890-3390
Mailing Address - Fax:336-890-3391
Practice Address - Street 1:1041 KIRKPATRICK RD STE 150
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-8068
Practice Address - Country:US
Practice Address - Phone:336-890-3390
Practice Address - Fax:336-890-3391
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103454363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1851340038Medicaid
LA2307665Medicaid
MS07478397Medicaid
NCP53546Medicare UPIN
LA2307665Medicaid