Healthcare Provider Details

I. General information

NPI: 1164490710
Provider Name (Legal Business Name): STACIE L PIERCE-DUTCH P.A.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 11/02/2026
Certification Date: 10/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8941 ENTRANCE RD BLDG 3334
APO AA
73145
US

IV. Provider business mailing address

8941 ENTRANCE RD BLDG 3334
APO AA
73145
US

V. Phone/Fax

Practice location:
  • Phone: 405-582-6827
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2809
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2809
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: