MEDICARE: MR. STACY WAYNE DENNIS PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA040	MS

General Provider Information

NPI Number	:	1902838162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STACY WAYNE DENNIS PA-C

Provider Business Mailing Address
First Line	:	46 SGT PRENTISS DR
Second Line	:	SUITE 103
City	:	NATCHEZ
State	:	MS
Zip	:	39120-4792
Country	:	US
Telephone Number	:	601-442-9654
Fax Number	:	601-442-9790

Provider Business Practice Location Address
First Line	:	46 SGT PRENTISS DR
Second Line	:	SUITE 103
City	:	NATCHEZ
State	:	MS
Zip	:	39120-4792
Country	:	US
Telephone Number	:	601-442-9654
Fax Number	:	601-442-9790

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	04/09/2008

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