Provider Demographics
NPI:1972813400
Name:BAYS, STACEY KAREN (IDMT)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:KAREN
Last Name:BAYS
Suffix:
Gender:F
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 LYNWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-4132
Mailing Address - Country:US
Mailing Address - Phone:208-420-4961
Mailing Address - Fax:
Practice Address - Street 1:509 LYNWOOD BLVD
Practice Address - Street 2:
Practice Address - City:TWIN FALLS
Practice Address - State:ID
Practice Address - Zip Code:83301-4132
Practice Address - Country:US
Practice Address - Phone:208-420-4961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians