Provider Demographics
NPI:1578163911
Name:JAMES, STACY (NP)
Entity type:Individual
Prefix:DR
First Name:STACY
Middle Name:
Last Name:JAMES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:
Other - Last Name:CARROLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:P.O. BOX 4168
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83205-4168
Mailing Address - Country:US
Mailing Address - Phone:208-239-1035
Mailing Address - Fax:208-239-3626
Practice Address - Street 1:777 HOSPITAL WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-5175
Practice Address - Country:US
Practice Address - Phone:208-239-3899
Practice Address - Fax:208-232-2195
Is Sole Proprietor?:No
Enumeration Date:2020-10-26
Last Update Date:2025-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMRN-75836363LF0000X
PASP030481363LF0000X
MDR248169363LF0000X
PAMJ9131614363LF0000X
MDMJ6513813363LF0000X
ID3371168363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily