Provider Demographics
NPI:1104600238
Name:STACY, CHRISTOPHER CALEB
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:CALEB
Last Name:STACY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-9281
Mailing Address - Country:US
Mailing Address - Phone:228-238-6892
Mailing Address - Fax:
Practice Address - Street 1:15 LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-9281
Practice Address - Country:US
Practice Address - Phone:228-238-6892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker