Provider Demographics
NPI:1649047143
Name:LISTER, STACY MICHELLE (ARNP- FNP-C)
Entity type:Individual
Prefix:MISS
First Name:STACY
Middle Name:MICHELLE
Last Name:LISTER
Suffix:
Gender:F
Credentials:ARNP- FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 SE DESTINATION DR
Mailing Address - Street 2:
Mailing Address - City:GRIMES
Mailing Address - State:IA
Mailing Address - Zip Code:50111-6608
Mailing Address - Country:US
Mailing Address - Phone:515-986-4524
Mailing Address - Fax:515-986-4531
Practice Address - Street 1:101 SE DESTINATION DR
Practice Address - Street 2:
Practice Address - City:GRIMES
Practice Address - State:IA
Practice Address - Zip Code:50111-6608
Practice Address - Country:US
Practice Address - Phone:515-986-4524
Practice Address - Fax:515-986-4531
Is Sole Proprietor?:No
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA176205363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily