Provider Demographics
NPI:1427285188
Name:STACY, EMILY C (APN, FNP)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:C
Last Name:STACY
Suffix:
Gender:F
Credentials:APN, FNP
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:C
Other - Last Name:STEFFEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 297
Mailing Address - Street 2:
Mailing Address - City:MEADOWVIEW
Mailing Address - State:VA
Mailing Address - Zip Code:24361-0297
Mailing Address - Country:US
Mailing Address - Phone:276-496-4492
Mailing Address - Fax:
Practice Address - Street 1:308 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SALTVILLE
Practice Address - State:VA
Practice Address - Zip Code:24370-3112
Practice Address - Country:US
Practice Address - Phone:276-496-4433
Practice Address - Fax:276-496-5923
Is Sole Proprietor?:No
Enumeration Date:2009-06-19
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000014238363L00000X
TN14238363LP0808X
VA0024169901363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1514520Medicaid
TN1514520Medicaid
VAVV5194BMedicare PIN
TN3345721Medicare PIN