Provider Demographics
NPI:1962232215
Name:BAUR, STACY DAVIS (NP)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:DAVIS
Last Name:BAUR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:PO BOX 959203
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-2804
Mailing Address - Country:US
Mailing Address - Phone:618-235-7065
Mailing Address - Fax:618-212-6677
Practice Address - Street 1:4700 MEMORIAL DR STE 350
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62226-5373
Practice Address - Country:US
Practice Address - Phone:618-235-7065
Practice Address - Fax:618-212-6677
Is Sole Proprietor?:No
Enumeration Date:2024-08-02
Last Update Date:2024-10-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL209030350363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner