Provider Demographics
NPI:1972828515
Name:SOUTER, STACIA ERIN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:STACIA
Middle Name:ERIN
Last Name:SOUTER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:STACIA
Other - Middle Name:ERIN
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:2111 AIRPARK DR
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-2433
Mailing Address - Country:US
Mailing Address - Phone:530-247-3733
Mailing Address - Fax:530-247-6807
Practice Address - Street 1:2111 AIRPARK DR
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-2433
Practice Address - Country:US
Practice Address - Phone:530-247-3733
Practice Address - Fax:530-247-6807
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-06
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16856363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily