Provider Demographics
NPI:1952509291
Name:CALDWELL, STACY (PA-C)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:
Last Name:CALDWELL
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 1:185 SW SHEVLIN HIXON DR STE 111
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-3263
Mailing Address - Country:US
Mailing Address - Phone:541-388-6789
Mailing Address - Fax:541-388-8504
Practice Address - Street 1:185 SW SHEVLIN HIXON DR STE 111
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3263
Practice Address - Country:US
Practice Address - Phone:541-388-6789
Practice Address - Fax:541-388-8504
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-09
Last Update Date:2021-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant