MEDICARE: STACEY NICOLE BRACEY PLPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator
2	101Y00000X	Counselor	PLC8796	LA
3	101Y00000X	Counselor
4	171M00000X	Case Manager/Care Coordinator	PLC8796	LA

General Provider Information

NPI Number	:	1255852158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY NICOLE BRACEY PLPC

Provider Business Mailing Address
First Line	:	3060 VALLEY CREEK DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70808-3169
Country	:	US
Telephone Number	:	225-923-3733
Fax Number	:	225-923-3735

Provider Business Practice Location Address
First Line	:	3060 VALLEY CREEK DR
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70808-3169
Country	:	US
Telephone Number	:	225-923-3733
Fax Number	:	225-923-3735

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2017
Last Update Date	:	07/18/2024

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