Provider Demographics
NPI:1801107115
Name:PYE, STACY MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:MARIE
Last Name:PYE
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 1:1709 BARNWELL ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2641
Mailing Address - Country:US
Mailing Address - Phone:803-254-3376
Mailing Address - Fax:803-254-3883
Practice Address - Street 1:1709 BARNWELL ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2641
Practice Address - Country:US
Practice Address - Phone:803-254-3376
Practice Address - Fax:803-254-3883
Is Sole Proprietor?:No
Enumeration Date:2010-07-01
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1528363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical