Provider Demographics
NPI:1063617439
Name:ROPER, STACEY SCHILLER (PA-C)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:SCHILLER
Last Name:ROPER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4414 LAKE BOONE TRL STE 402
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-7520
Mailing Address - Country:US
Mailing Address - Phone:919-784-7460
Mailing Address - Fax:919-784-7461
Practice Address - Street 1:2605 BLUE RIDGE RD STE 190
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6475
Practice Address - Country:US
Practice Address - Phone:919-784-7460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103792363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNC8735CMedicare PIN