Provider Demographics
NPI:1932912417
Name:KOONCE, STACEY RENEE (RN)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:RENEE
Last Name:KOONCE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5029 NC HIGHWAY 87 S
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28306-3391
Mailing Address - Country:US
Mailing Address - Phone:910-578-0658
Mailing Address - Fax:
Practice Address - Street 1:1638 OWEN DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3424
Practice Address - Country:US
Practice Address - Phone:910-615-5094
Practice Address - Fax:910-615-5026
Is Sole Proprietor?:No
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC171953163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency