Stacy, Pamela Renee
Stacy, Pamela Renee is an individual health care provider with primary practice located at 8288 S Broadway Ave , Tyler TX 75703-5262. She recently has 3 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, Physician Assistants & Advanced Practice Nursing Providers / Acute Care, Physician Assistants & Advanced Practice Nursing Providers / Family. Physician Assistants & Advanced Practice Nursing Providers / Family is her primary health care specialty. Stacy, Pamela Renee can be contacted via phone (903) 606-7060.Contact Information
Primary practice address
8288 S Broadway Ave
Tyler TX 75703-5262
Phone: (903) 606-7060
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner | 363L00000X | AP121213 | Texas |
| Physician Assistants & Advanced Practice Nursing Providers / Acute Care | 363LA2100X | AP121213 | Texas |
| Physician Assistants & Advanced Practice Nursing Providers / Acute Care | 363LA2100X | 729458 | Texas |
| Physician Assistants & Advanced Practice Nursing Providers / Family | 363LF0000X | AP121213 | Texas |
Profile Details
| NPI number | 1821367327 |
|---|---|
| LBN Legal business name | Stacy, Pamela Renee |
| Credentials | ACNP |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 29th, 2011 |
| Last updated | Oct 28th, 2022 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1821367327 | NPPES |
| Texas | Other | 75-2616977-118 | TRICARE |
| Texas | MEDICAID | 293825001 | TRICARE |
| Texas | Other | 75-2616977-007 | TRICARE |
| Texas | Other | 867N10 | TRICARE |
| Texas | Other | 75-2616977-066 | TRICARE |
| Texas | Other | 752616977042 | TRICARE |
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