Provider Demographics
NPI:1457355166
Name:MCCORD, STACIE L (MD)
Entity Type:Individual
Prefix:DR
First Name:STACIE
Middle Name:L
Last Name:MCCORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 RODGERS DR
Mailing Address - Street 2:STE. A
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-7434
Mailing Address - Country:US
Mailing Address - Phone:501-380-3297
Mailing Address - Fax:
Practice Address - Street 1:415 RODGERS DR
Practice Address - Street 2:STE. A
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-7434
Practice Address - Country:US
Practice Address - Phone:501-380-3297
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR1839174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR154742001Medicaid
ARI00683Medicare UPIN
AR154742001Medicaid