Provider Demographics
NPI:1215489356
Name:HOCKETT, STACY (APRN, AGACNP-BC)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:HOCKETT
Suffix:
Gender:F
Credentials:APRN, AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1933 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-5133
Mailing Address - Country:US
Mailing Address - Phone:325-658-6524
Mailing Address - Fax:817-702-8445
Practice Address - Street 1:1933 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-5133
Practice Address - Country:US
Practice Address - Phone:325-658-6524
Practice Address - Fax:325-658-8895
Is Sole Proprietor?:No
Enumeration Date:2016-10-24
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132376363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX732170OtherMEDICARE
TX385085103Medicaid