Provider Demographics
NPI:1073812251
Name:BUCK, STACIE LYNN (DPM)
Entity type:Individual
Prefix:DR
First Name:STACIE
Middle Name:LYNN
Last Name:BUCK
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11751 ROCK LANDING DR STE 6
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4233
Mailing Address - Country:US
Mailing Address - Phone:757-327-0657
Mailing Address - Fax:
Practice Address - Street 1:11751 ROCK LANDING DR STE 6
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4233
Practice Address - Country:US
Practice Address - Phone:757-327-0657
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-27
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103301063213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist