Provider Demographics
NPI:1427708981
Name:STAPPER, ELIZABETH JOY (PA-C)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JOY
Last Name:STAPPER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 VISION PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77384-3023
Mailing Address - Country:US
Mailing Address - Phone:281-315-8130
Mailing Address - Fax:
Practice Address - Street 1:522 TIMBERDALE LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-3063
Practice Address - Country:US
Practice Address - Phone:281-440-5006
Practice Address - Fax:281-719-5935
Is Sole Proprietor?:No
Enumeration Date:2022-03-28
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA15587207RR0500X, 363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant