Provider Demographics
NPI:1831269521
Name:OWENS, STACY JO (NP-C)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:JO
Last Name:OWENS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 W SUNSET ST STE 104
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-6041
Mailing Address - Country:US
Mailing Address - Phone:417-269-4663
Mailing Address - Fax:417-269-0692
Practice Address - Street 1:2240 W SUNSET ST STE 104
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-6041
Practice Address - Country:US
Practice Address - Phone:417-269-4663
Practice Address - Fax:417-269-0692
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004029814363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO429411218Medicaid