Provider Demographics
NPI:1316839046
Name:STEPHENS, STACEY LYNN (AGNP-C)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:LYNN
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:LYNN
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:225 W WASHINGTON ST STE 1500
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-3485
Mailing Address - Country:US
Mailing Address - Phone:855-493-5523
Mailing Address - Fax:
Practice Address - Street 1:209 S CENTRAL AVE STE 300
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:WI
Practice Address - Zip Code:54449-2836
Practice Address - Country:US
Practice Address - Phone:614-439-0203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17067-33363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health