Provider Demographics
NPI:1972590941
Name:MCSTACY, CLAIR LEA (CNM)
Entity type:Individual
Prefix:
First Name:CLAIR
Middle Name:LEA
Last Name:MCSTACY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 BEDFORD AVE
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24523-1966
Mailing Address - Country:US
Mailing Address - Phone:540-586-7952
Mailing Address - Fax:540-586-7950
Practice Address - Street 1:600 BEDFORD AVE
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:VA
Practice Address - Zip Code:24523-1966
Practice Address - Country:US
Practice Address - Phone:540-586-7952
Practice Address - Fax:540-586-7950
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001163577367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010143187Medicaid
VA010166560Medicaid