Healthcare Provider Details

I. General information

NPI: 1841872165
Provider Name (Legal Business Name): STACEY STAGE PNP-AC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STACEY MEAD

II. Dates (important events)

Enumeration Date: 04/26/2021
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 CONSTANTIN BLVD
BATON ROUGE LA
70809-3489
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 225-374-1528
  • Fax: 225-374-1611
Mailing address:
  • Phone: 225-374-1528
  • Fax: 225-765-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number219394
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363LP0222X
TaxonomyCritical Care Pediatric Nurse Practitioner
License Number219394
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: