Stacey E Bacon
Nurse Practitioner - Family Medicine
1701 S Broadway St
Pittsburg
, Kansas 66762-5856
Stacey E Bacon
Nurse Practitioner - Family Medicine
1701 S Broadway St
Pittsburg
, Kansas 66762-5856
(620) 235-4452
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About
Features
Specialties
- Nurse Practitioner - Family Medicine
Languages spoken
- English
Location
First Address
- Stacey E Bacon
- 1701 S Broadway St
- Pittsburg, KS
- Zip : 66762-5856
- Phone : (620) 235-4452
Second Address
- Stacey E Bacon
- 1701 S Broadway St
- Pittsburg, KS
- Zip : 66762-5856
- Phone : (620) 235-4452
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| N | 363LF0000X | Nurse Practitioner - Family Medicine | 2004015211 | MO |
| Y | 363LF0000X | Nurse Practitioner - Family Medicine | 75561 | KS |
National Provider Identifier
| NPI | 1003066085 |
|---|---|
| Provider Name | Stacey E Bacon |
| First Address | Pittsburg, KS 66762-5856 |
| Second Address | Pittsburg, KS 66762-5856 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 25/09/2008 |
| Last Update Date | 07/02/2020 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.