Provider Demographics
NPI:1891793758
Name:DAVIDS, STACY ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:ANN
Last Name:DAVIDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:STACY
Other - Middle Name:
Other - Last Name:FARNHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:35 LYNX LN
Mailing Address - Street 2:
Mailing Address - City:NORTH LIBERTY
Mailing Address - State:IA
Mailing Address - Zip Code:52317-9000
Mailing Address - Country:US
Mailing Address - Phone:319-440-9851
Mailing Address - Fax:319-449-3845
Practice Address - Street 1:1150 5TH ST STE 270
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241
Practice Address - Country:US
Practice Address - Phone:319-804-9312
Practice Address - Fax:319-449-3845
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5N622084P0800X
IA406262084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOG44502Medicare UPIN