Provider Demographics
NPI:1013325968
Name:DESCHAMPS, STACEY ANN (ARNP)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:ANN
Last Name:DESCHAMPS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:550 GAGE BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-9532
Mailing Address - Country:US
Mailing Address - Phone:509-942-3627
Mailing Address - Fax:509-627-2983
Practice Address - Street 1:602 N COLORADO ST
Practice Address - Street 2:SUITE D
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7825
Practice Address - Country:US
Practice Address - Phone:509-735-8600
Practice Address - Fax:509-783-7354
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-76253-092363LA2100X
OR201401374NP-PP363LA2100X
WAAP 60489248363LA2100X
WAAP60489248363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1013325968Medicaid