Provider Demographics
NPI:1528706736
Name:CARON, STACY LYNN (AGPCNP)
Entity type:Individual
Prefix:MS
First Name:STACY
Middle Name:LYNN
Last Name:CARON
Suffix:
Gender:F
Credentials:AGPCNP
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:LYNN
Other - Last Name:PIRES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 MILL RD
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5252
Mailing Address - Country:US
Mailing Address - Phone:508-973-3228
Mailing Address - Fax:508-973-3215
Practice Address - Street 1:200 MILL RD
Practice Address - Street 2:
Practice Address - City:FAIRHAVEN
Practice Address - State:MA
Practice Address - Zip Code:02719-5252
Practice Address - Country:US
Practice Address - Phone:508-973-3228
Practice Address - Fax:508-973-3215
Is Sole Proprietor?:No
Enumeration Date:2022-05-26
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2301388363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology