Provider Demographics
NPI:1104804582
Name:STOKKE, LIBBIE SUE (CNP-PMHNP, FNP)
Entity type:Individual
Prefix:
First Name:LIBBIE
Middle Name:SUE
Last Name:STOKKE
Suffix:
Gender:F
Credentials:CNP-PMHNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 WEST LOOP 281
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75604
Mailing Address - Country:US
Mailing Address - Phone:903-295-8990
Mailing Address - Fax:903-295-8987
Practice Address - Street 1:911 W LOOP 281 STE 300
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604-2934
Practice Address - Country:US
Practice Address - Phone:903-295-8990
Practice Address - Fax:903-295-8987
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR26277363L00000X
MNR158703-0363LF0000X, 363LP0808X
TXAP125504363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND19805Medicaid
ND71540Medicare ID - Type Unspecified
NDS60496Medicare UPIN