Provider Demographics
NPI:1154606168
Name:VARLEY, ELIZABETH STACY (APRN)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:STACY
Last Name:VARLEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 MEMORY LANE
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:77879
Mailing Address - Country:US
Mailing Address - Phone:979-596-1441
Mailing Address - Fax:979-596-2237
Practice Address - Street 1:600 MEMORY LANE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:TX
Practice Address - Zip Code:77879-5073
Practice Address - Country:US
Practice Address - Phone:979-596-1441
Practice Address - Fax:979-596-2237
Is Sole Proprietor?:No
Enumeration Date:2011-10-21
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX505684363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner