Provider Demographics
NPI:1386392926
Name:STARK, STACY JEAN
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:JEAN
Last Name:STARK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 HARDING AVE
Mailing Address - Street 2:
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-5858
Mailing Address - Country:US
Mailing Address - Phone:515-735-2016
Mailing Address - Fax:
Practice Address - Street 1:1217 HARDING AVE
Practice Address - Street 2:
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-5858
Practice Address - Country:US
Practice Address - Phone:515-735-2016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care