Healthcare Provider Details

I. General information

NPI: 1982348710
Provider Name (Legal Business Name): NATHANIEL PERRY STACY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2022
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BARNES JEWISH HOSPITAL PLZ
SAINT LOUIS MO
63110-1003
US

IV. Provider business mailing address

325 MAINE STREET MSO LIBRARY
LAWRENCE KS
66044
US

V. Phone/Fax

Practice location:
  • Phone: 314-362-3296
  • Fax:
Mailing address:
  • Phone: 785-505-2988
  • Fax: 785-505-5228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number04-53132
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: