Provider Demographics
NPI:1104172535
Name:EAVES, STACEY WRIGHT (ACNP)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:WRIGHT
Last Name:EAVES
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 HOSPITAL DR
Mailing Address - Street 2:STE. 450
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-2394
Mailing Address - Country:US
Mailing Address - Phone:318-752-2328
Mailing Address - Fax:318-746-0160
Practice Address - Street 1:2300 HOSPITAL DR
Practice Address - Street 2:STE. 450
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-2394
Practice Address - Country:US
Practice Address - Phone:318-752-2328
Practice Address - Fax:318-746-0160
Is Sole Proprietor?:No
Enumeration Date:2012-08-03
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07073363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care