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MRS. STACY ANNETTE CHURCH PA-C
NPI 1114930658
Physician Assistant - Medical in Charleston, WV

Active since August 15, 2006PECOS Enrolled
3100 MACCORKLE AVE SE, SUITE 610, CHARLESTON, WV 25304(304) 346-1141(304) 346-1142 Get Directions Write a Review

NPPES record last updated: June 21, 2011. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Mrs. Stacy Annette Church Pa-c NPPES

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

MRS. STACY ANNETTE CHURCH PA-C (NPI 1114930658) is an individual medical provider in Charleston, West Virginia, licensed in West Virginia (01163) and active in the NPI registry since August 2006. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1114930658
Entity TypeIndividualFemale
Primary Taxonomy363AM0700X
Provider Legal NameMRS. STACY ANNETTE CHURCHCredential: PA-C
Location Address3100 MACCORKLE AVE SE, SUITE 610Charleston, WV 25304-1223
Mailing Address3100 Maccorkle Ave Se, Suite 610Charleston, WV 25304-1223 · (304) 346-1141
Phone(304) 346-1141
Fax(304) 346-1142
Sole ProprietorNo
Enumeration DateAugust 15, 2006
Last NPPES UpdateJune 21, 2011
✔ NPI 1114930658 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 WV · 01163
3100 MACCORKLE AVE SE, Charleston, WV 25304
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Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mrs. Stacy Annette Church Pa-c is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

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.

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.

DARSHANKUMAR ASHWINBHAI DAVE MD
Psychiatry & Neurology (Neurology)
3100 MACCORKLE AVE SE, SUITE 802
CHARLESTON, WV 25304
Kanawha County (304) 343-4400
DR. SCOTT EDWARD MILLER MD
Internal Medicine (Cardiovascular Disease)
3100 MACCORKLE AVE SE, SUITE 610
CHARLESTON, WV 25304
Kanawha County (304) 346-1141
KURT M. NELLHAUS, M.D.
Internal Medicine (Pulmonary Disease)
3100 MACCORKLE AVE SE, SUITE 806
CHARLESTON, WV 25304
Kanawha County (304) 344-9480
NANCY RABEL CANTERBURY MA
Psychologist (Clinical)
3100 MACCORKLE AVE SE, SUITE 401
CHARLESTON, WV 25304
Kanawha County (304) 346-6161
AMANDA L. NEWCOMER NP-C
Nurse Practitioner (Family)
3100 MACCORKLE AVE SE, SUITE 301
CHARLESTON, WV 25304
Kanawha County (304) 388-5395
MR. KATHLEEN A MANNION PA
Physician Assistant
3100 MACCORKLE AVE SE, SUITE 411
CHARLESTON, WV 25304
Kanawha County (304) 343-7576
JENNIFER J. HANCOCK PSY D
Psychologist (Clinical)
3100 MACCORKLE AVE SE, SUITE 101
CHARLESTON, WV 25304
Kanawha County (304) 388-8380
CMC PHARMACY, LLC
Pharmacy (Home Infusion Therapy Pharmacy)
3100 MACCORKLE AVE SE, SUITE 100
CHARLESTON, WV 25304
Kanawha County (304) 344-8021

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 Stacy Church's NPI number?

The NPI number for Stacy Church is 1114930658. It was assigned to this individual provider in the NPPES registry on August 15, 2006.

Where is Stacy Church located?

Stacy Church practices at 3100 Maccorkle Ave SE Suite 610, Charleston, WV 25304. The listed phone number is (304) 346-1141.

What is Stacy Church's specialty?

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

Is Stacy Church enrolled in Medicare?

Yes. Stacy Church is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Stacy Church was last updated on June 21, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.