Provider Demographics
NPI:1740323997
Name:LEMIRE, STACEY S (PA-C)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:S
Last Name:LEMIRE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7101 W HOOD PL STE A101
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-6720
Mailing Address - Country:US
Mailing Address - Phone:509-581-3100
Mailing Address - Fax:509-436-1948
Practice Address - Street 1:7101 W HOOD PL STE A101
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-6720
Practice Address - Country:US
Practice Address - Phone:509-581-3100
Practice Address - Fax:509-436-1948
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004052363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0255982OtherLABOR & INDUSTRIES
WA8886250Medicare PIN