Stacey Clark, PA
Physician Assistant in Penacook, New Hampshire
1710968763- Practice location
- 4 Crescent St., Penacook, NH 03303-1412
- Phone
- 603-753-4302
- Fax
- 603-227-7570
- Last updated
- September 30, 2022
Stacey Clark is a Physician Assistant based in Penacook, NH. Stacey Clark practices in Penacook, NH and has the professional credentials of PA. The NPI Number for Stacey Clark is 1710968763 and holds a License No. 2511 (AZ). The current practice location address for Stacey Clark is 4 Crescent St., Penacook, NH 03303-1412 and can be reached out via phone at 603-753-4302 and via fax at 603-227-7570.
Provider Profile Details
- NPI Number
- 1710968763
- Provider Name
- Stacey Clark
- Credential
- PA
- Provider Entity Type
- Individual
- Gender
- Female
- Address
- 4 Crescent St., Penacook, NH 03303-1412
- Phone Number
- 603-753-4302
- Fax Number
- 603-227-7570
- Primary Taxonomy
- Physician Assistant · 363A00000X
- Sole Proprietor
- No
- Other Names
- -- Stacey Ort, PA (Former Name)
- Provider Enumeration Date
- November 8, 2005
- Last Update Date
- September 30, 2022
- Certification Date
- September 30, 2022
- NPI Status
- Active
Provider Business Practice Location Address Details
- Address
- 4 Crescent St.
Penacook, NH 03303-1412 - City
- Penacook
- State
- New Hampshire
- Zip
- 03303-1412
- Phone Number
- 603-753-4302
- Fax Number
- 603-227-7570
Provider Business Mailing Address Details
- Address
- 4 Crescent St
Penacook, NH 03303-1412 - City
- Penacook
- State
- NH
- Zip
- 03303-1412
- Phone Number
- 603-753-4302
License Information
- License Number (1)
- 2511
- License State (1)
- AZ
- Taxonomy (1)
- Physician Assistant, Medical · 363AM0700X
- License Number (2)
- 0622
- License State (2)
- NH
- Taxonomy (2)
- Physician Assistant · 363A00000X · Primary
Legacy Identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| No legacy identifiers (Medicaid, Medicare or plan IDs) are on file for this provider. | |||
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Frequently Asked Questions
What is the NPI number of Stacey Clark, PA?
The NPI number of Stacey Clark, PA is 1710968763. It was assigned on November 8, 2005 and is currently active in the NPPES registry.
What is the specialty of Stacey Clark, PA?
Stacey Clark, PA is registered under the primary taxonomy Physician Assistant (code 363A00000X), licensed in AZ under license number 2511.
Where does Stacey Clark, PA practice?
The practice location is 4 Crescent St., Penacook, NH 03303-1412. The office can be reached at 603-753-4302 (phone) or 603-227-7570 (fax).
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). It is used in HIPAA standard transactions.
How do I verify this NPI record?
This record is sourced from the public NPPES NPI Registry maintained by CMS. You can confirm it by searching NPI 1710968763 directly on the NPPES registry website.