Provider Demographics
NPI:1265162531
Name:PARTIN, STACY RENAE (MMSC)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:RENAE
Last Name:PARTIN
Suffix:
Gender:F
Credentials:MMSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2705 MCGEE TRFY APT 2104
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64108-3922
Mailing Address - Country:US
Mailing Address - Phone:252-497-0046
Mailing Address - Fax:
Practice Address - Street 1:1 S. PENN SQ.
Practice Address - Street 2:SUITE 960
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107
Practice Address - Country:US
Practice Address - Phone:215-351-2331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSGC0352479170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS