Provider Demographics
NPI:1225334790
Name:STOCKMAN, JAMES ROBERT JR (CRNA)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ROBERT
Last Name:STOCKMAN
Suffix:JR
Gender:
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 N STALLINGS DR STE 405
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75964-1222
Mailing Address - Country:US
Mailing Address - Phone:936-254-4703
Mailing Address - Fax:936-560-6933
Practice Address - Street 1:1023 N MOUND ST STE A
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-4453
Practice Address - Country:US
Practice Address - Phone:936-564-8611
Practice Address - Fax:936-564-4155
Is Sole Proprietor?:No
Enumeration Date:2011-02-01
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP119935207LP2900X, 367500000X
TX712738367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX086764OtherAANA LICENSE
TX712738OtherNURSING LICENSE