Healthcare Provider Details

I. General information

NPI: 1144125121
Provider Name (Legal Business Name): STACY FALCON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2026
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5865 RIDGEWAY CENTER PKWY STE 300
MEMPHIS TN
38120-4014
US

IV. Provider business mailing address

5865 RIDGEWAY CENTER PKWY STE 300
MEMPHIS TN
38120-4014
US

V. Phone/Fax

Practice location:
  • Phone: 888-716-1676
  • Fax: 888-716-1676
Mailing address:
  • Phone: 888-716-1676
  • Fax: 888-716-1676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberNPCN-17649-16309
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: