Healthcare Provider Details

I. General information

NPI: 1255737136
Provider Name (Legal Business Name): STACY ANN RICHEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2014
Last Update Date: 12/22/2023
Certification Date: 12/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4248 HARBOR BEACH BLVD
BRIGANTINE NJ
08203-1361
US

IV. Provider business mailing address

307 KIETRO DR
LINWOOD NJ
08221-1522
US

V. Phone/Fax

Practice location:
  • Phone: 609-266-0400
  • Fax: 866-912-0605
Mailing address:
  • Phone: 609-412-0922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00343700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: