Most Relevant Information
Provider Data
| NPI Number: | 1003066085 |
| Provider Name: | STACEY E BACON NP-C |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | 2004015211 |
Most Important Dates
| Enumeration Date: | 09/25/2008 |
| Last Updated: | 02/07/2020 |
Provider Practice Location
1701 S BROADWAY ST
PITTSBURG
KS
667625856
Practice Location Phone/Fax
| Phone: | 6202354452 |
| Fax: |
Provider Mailing Location
1701 S BROADWAY ST
PITTSBURG
KS
667625856
Provider Mailing Phone/Fax
| Phone: | 6202354452 |
| Fax: |