Provider Demographics
NPI:1972016590
Name:OWENS, STACY JEHAN
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:JEHAN
Last Name:OWENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5951 CUSPIDON CV
Mailing Address - Street 2:
Mailing Address - City:MILLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38053-8423
Mailing Address - Country:US
Mailing Address - Phone:901-644-3610
Mailing Address - Fax:
Practice Address - Street 1:7505 US HIGHWAY 64 STE 105
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38133-8939
Practice Address - Country:US
Practice Address - Phone:901-347-2003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-06
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management