Provider Demographics
NPI:1528514528
Name:YANCEY, STACY (CRNA)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:YANCEY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3979 NAVY PL
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-9443
Mailing Address - Country:US
Mailing Address - Phone:336-870-3484
Mailing Address - Fax:
Practice Address - Street 1:401 FERNDALE BLVD
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27262-4739
Practice Address - Country:US
Practice Address - Phone:336-882-2567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC113039367500000X
NC245610163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC245610OtherNC BOARD OF NURSING