Provider Demographics
NPI:1972211175
Name:BRAUSCH, STACEY JEAN (AGNP-BC)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:JEAN
Last Name:BRAUSCH
Suffix:
Gender:F
Credentials:AGNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MACCLESFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27852
Mailing Address - Country:US
Mailing Address - Phone:919-330-8127
Mailing Address - Fax:
Practice Address - Street 1:705 WH SMITH BLVD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-3752
Practice Address - Country:US
Practice Address - Phone:252-329-8482
Practice Address - Fax:252-558-0788
Is Sole Proprietor?:No
Enumeration Date:2022-11-07
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5017192363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care