Healthcare Provider Details

I. General information

NPI: 1215311592
Provider Name (Legal Business Name): STACEY MICHELLE AKERS CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2015
Last Update Date: 07/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 JOSEPH SIEWICK DR SUITE 300
FAIRFAX VA
22033-1744
US

IV. Provider business mailing address

3700 JOSEPH SIEWICK DR SUITE 300
FAIRFAX VA
22033-1744
US

V. Phone/Fax

Practice location:
  • Phone: 703-569-8400
  • Fax: 703-758-7602
Mailing address:
  • Phone: 703-569-8400
  • Fax: 703-758-7602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number0024172762
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: