Provider Demographics
NPI:1912351404
Name:UTTON, STACY
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:UTTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5160 AMBERLY RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-3629
Mailing Address - Country:US
Mailing Address - Phone:757-687-8485
Mailing Address - Fax:
Practice Address - Street 1:1101 FIRST COLONIAL RD
Practice Address - Street 2:STE. 300
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-2409
Practice Address - Country:US
Practice Address - Phone:757-481-4817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-20
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001181340163WG0100X
VA0024173588363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0100XNursing Service ProvidersRegistered NurseGastroenterology