Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Stacey Renee Haveman, PHYSICIANASSISTANT

Individual provider Medical Physician Assistant · NPI 1023309796

Stacey Renee Haveman, PHYSICIANASSISTANT is a Physician Assistant in Walla Walla, Washington. Qualified in 2010, 16 years ago. Practices with Privia Medical Group Washington PLLC, a 72-clinician group and accepts Medicare assignment. Licensed in Washington.

Years since qualifying
16
Licensed in
WA
In the registry since
2011

Practice location Address checks out

55 W Tietan St
Walla Walla, WA 99362-4445
Phone: (509) 525-3720
Fax: (509) 522-1592
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence PA60389054 (WA)

Record details

NPI number1023309796
Entity typeIndividual (Type 1)
GenderFemale
Credentials PHYSICIANASSISTANT
Sole proprietorNo
NPI enumeratedApril 28, 2011
Last updated in NPPESJanuary 18, 2016

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2010 (16 years in practice)
Group practice Privia Medical Group Washington Pllc — 72 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Walla Walla