Provider Demographics
NPI:1306972500
Name:SISSON, STACY JANE (RN)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:JANE
Last Name:SISSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5608 CLIFF CAVE CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-4368
Mailing Address - Country:US
Mailing Address - Phone:314-846-1161
Mailing Address - Fax:314-846-1161
Practice Address - Street 1:5608 CLIFF CAVE CROSSING DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-4368
Practice Address - Country:US
Practice Address - Phone:314-846-1161
Practice Address - Fax:314-846-1161
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO143216163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice