| Doctor Name: | STACEY E BACON |
| NPI Number: | 1003066085 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | NP-C |
| License Number: | 2004015211 |
| Business Practice Address: | 2216 E 32nd St Ste 101 Joplin, MO - 648043015 |
| Business Phone Number: | 4176248730 |
| Business Fax Number: | 4176248745 |
| Mailing Address: | Po Box 3480, JOPLIN |
| State: | MO |
| Postal Code: | 648033480 |
| Phone Number: | 4176248730 |
| Fax Number: | 4176248745 |
| NPI Enumeration Date: | 09/25/2008 |
| NPI Last Update Date: | 11/10/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 2004015211 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |