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General NPI Number Information
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NPI Number | 1780131037
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Entity Type | Individual
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Provider Name | STACEY ELIZABETH MYRICK APRN, WHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/03/2016
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Last Update Date | 04/23/2025
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Provider Practice Location Address
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Address Line | 21 STAR RD
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City | EDGEFIELD
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State | SC
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Zip | 29824-4209
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Country | US
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Telephone | 803-507-0696
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Fax |
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Provider Business Mailing Address
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Address Line | 1915 NEW HOLLAND RD
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City | WAGENER
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State | SC
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Zip | 29164-9483
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Country | US
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Telephone | 803-845-9123
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 20920
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License Number State | SC
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