Provider Demographics
NPI:1992332563
Name:OVERMAN, STACY AMANDA (PA-C)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:AMANDA
Last Name:OVERMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 7TH AVE SE UNIT 10
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:IA
Mailing Address - Zip Code:50009-2119
Mailing Address - Country:US
Mailing Address - Phone:151-520-5754
Mailing Address - Fax:
Practice Address - Street 1:925 PORTER AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50315-7267
Practice Address - Country:US
Practice Address - Phone:515-285-6781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program