Provider Demographics
NPI:1932249356
Name:MEVS, STACY R (MD)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:R
Last Name:MEVS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:STACY
Other - Middle Name:
Other - Last Name:MEVS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:201 BJC SAINT PETERS DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-3386
Mailing Address - Country:US
Mailing Address - Phone:636-916-9615
Mailing Address - Fax:
Practice Address - Street 1:201 BJC SAINT PETERS DR STE 200
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-3386
Practice Address - Country:US
Practice Address - Phone:636-916-9615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06996700207Q00000X
MO2021045311207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3051404Medicaid
NJF72781Medicare UPIN
NJ3051404Medicaid