Provider Demographics
NPI:1780131037
Name:MYRICK, STACEY ELIZABETH (APRN, WHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:ELIZABETH
Last Name:MYRICK
Suffix:
Gender:
Credentials:APRN, WHNP-BC
Other - Prefix:MRS
Other - First Name:STACEY
Other - Middle Name:ELIZABETH
Other - Last Name:GAUNCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1915 NEW HOLLAND RD
Mailing Address - Street 2:
Mailing Address - City:WAGENER
Mailing Address - State:SC
Mailing Address - Zip Code:29164-9483
Mailing Address - Country:US
Mailing Address - Phone:803-845-9123
Mailing Address - Fax:
Practice Address - Street 1:21 STAR RD
Practice Address - Street 2:
Practice Address - City:EDGEFIELD
Practice Address - State:SC
Practice Address - Zip Code:29824-4209
Practice Address - Country:US
Practice Address - Phone:803-507-0696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-03
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20920363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health