1. Home
  2. Directory
  3. Washington
  4. Walla Walla
  5. Physician Assistant
  6. NPI Profile

STACEY RENEE HAVEMAN PHYSICIAN ASSISTANT
NPI 1023309796
Physician Assistant - Medical in Walla Walla, WA

Active since April 28, 2011PECOS EnrolledAccepts Medicare Assignment
55 W TIETAN ST, WALLA WALLA, WA 99362(509) 525-3720(509) 522-1592 Get Directions Write a Review

NPPES record last updated: January 18, 2016. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Stacey Renee Haveman Physician Assistant NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

STACEY RENEE HAVEMAN PHYSICIAN ASSISTANT (NPI 1023309796) is an individual medical provider in Walla Walla, Washington, licensed in Washington (PA60389054) and active in the NPI registry since April 2011. She is enrolled in Medicare PECOS, is affiliated with Providence St Mary Medical Center, and is a graduate of Other (2010).

NPPES Registry Identity

NPI1023309796
Entity TypeIndividualFemale
Primary Taxonomy363AM0700X
Provider Legal NameSTACEY RENEE HAVEMANCredential: PHYSICIAN ASSISTANT
Location Address55 W TIETAN STWalla Walla, WA 99362-4445
Mailing Address55 W Tietan StWalla Walla, WA 99362-4445 · (509) 525-3720 · Fax (509) 522-1592
Phone(509) 525-3720
Fax(509) 522-1592
Sole ProprietorNo
Medical School CMSOtherGraduated 2010
Enumeration DateApril 28, 2011
Last NPPES UpdateJanuary 18, 2016
✔ NPI 1023309796 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AM0700X
License✔ Licensed in WA · PA60389054
55 W TIETAN ST, Walla Walla, WA 99362
Open in Google Maps ↗

Other Names 1

Former Name (1)Stacey Renee Cowan Physician Assistant

Other Identifiers 2

Medicaid03465758NY
Medicare PINJ400045859NY

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Moda Health Plan, Inc., PacificSource Health Plans, Premera Blue Cross Blue Shield of Alaska and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Stacey Renee Haveman Physician Assistant is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID3375729734
PECOS Enrollment IDI20131119001214
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Providence St Mary Medical Center

Acute Care Hospitals · Walla Walla, WA
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number500002
Location401 W Poplar StWalla Walla, WA 99362 · Walla Walla County
Emergency services Birthing friendly

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KEVIN JON MOLANDER M.D.
Family Medicine
55 W TIETAN ST
WALLA WALLA, WA 99362
Walla Walla County (509) 525-3720
JUSTIN OLSWANGER DO
Family Medicine (Adult Medicine)
55 W TIETAN ST
WALLA WALLA, WA 99362
Walla Walla County (509) 525-3720
DR. JOHN ERIC MOORE D.O.
Family Medicine
55 W TIETAN ST
WALLA WALLA, WA 99362
Walla Walla County (509) 525-3720
TIMOTHY ISAMU O'CONNOR M.D.
Pediatrics
55 W TIETAN ST
WALLA WALLA, WA 99362
Walla Walla County (509) 525-3720
REBEKAH DICKMAN M.D.
Pediatrics
55 W TIETAN ST
WALLA WALLA, WA 99362
Walla Walla County (509) 525-3720
DIANA FITZGERALD AU.D.
Audiologist
55 W TIETAN ST
WALLA WALLA, WA 99362
Walla Walla County (509) 525-3720
GUNNAR LEIGHTON JAMES SJOREN DPT
Physical Therapist
55 W TIETAN ST
WALLA WALLA, WA 99362
Walla Walla County (509) 525-3720
EMILY GRACE CASTILLO ARNP
Nurse Practitioner (Adult Health)
55 W TIETAN ST
WALLA WALLA, WA 99362
Walla Walla County (509) 525-3720

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Stacey Haveman's NPI number?

The NPI number for Stacey Haveman is 1023309796. It was assigned to this individual provider in the NPPES registry on April 28, 2011. The provider is also known as Stacey Renee Cowan Physician Assistant.

Where is Stacey Haveman located?

Stacey Haveman practices at 55 W Tietan St, Walla Walla, WA 99362. The listed phone number is (509) 525-3720.

What is Stacey Haveman's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Is Stacey Haveman enrolled in Medicare?

Yes. Stacey Haveman is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Stacey Haveman accept?

Health plans from Moda Health Plan, Inc., PacificSource Health Plans, Premera Blue Cross Blue Shield of Alaska and Providence Health Plan list Stacey Haveman as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Stacey Haveman affiliated with any hospitals?

According to CMS data, Stacey Haveman is affiliated with Providence St Mary Medical Center.

When was this NPI record last updated?

The NPPES record for Stacey Haveman was last updated on January 18, 2016. NPI Profile syncs with the weekly NPPES data releases published by CMS.