Provider Demographics
NPI:1588322069
Name:CHAFFIN, STACIE (WHNP-BC)
Entity type:Individual
Prefix:
First Name:STACIE
Middle Name:
Last Name:CHAFFIN
Suffix:
Gender:
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 776084
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6084
Mailing Address - Country:US
Mailing Address - Phone:314-919-2600
Mailing Address - Fax:314-919-2677
Practice Address - Street 1:1000 DES PERES RD STE 300
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-2040
Practice Address - Country:US
Practice Address - Phone:314-919-2600
Practice Address - Fax:314-919-2677
Is Sole Proprietor?:No
Enumeration Date:2021-12-02
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209022260363LW0102X
MO2021023515363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health