| Doctor Name: | MRS. JESSICA L STACY |
| NPI Number: | 1407151780 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | 95002256 |
| Business Practice Address: | 611 W Main St Fredericktown, MO - 636451111 |
| Business Phone Number: | 5737834111 |
| Business Fax Number: | 5737831024 |
| Mailing Address: | 1000 Vale Terrace Dr, VISTA |
| State: | CA |
| Postal Code: | 920845218 |
| Phone Number: | 7606315000 |
| Fax Number: | |
| NPI Enumeration Date: | 01/19/2011 |
| NPI Last Update Date: | 08/03/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LP2300X |
| License Number: | 95002256 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |