Provider Demographics
NPI:1598585523
Name:SHOEMAKER, STACIE DAWN (AGNP-C)
Entity type:Individual
Prefix:
First Name:STACIE
Middle Name:DAWN
Last Name:SHOEMAKER
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 W NAVASOTA ST
Mailing Address - Street 2:
Mailing Address - City:GROESBECK
Mailing Address - State:TX
Mailing Address - Zip Code:76642-1636
Mailing Address - Country:US
Mailing Address - Phone:254-707-0990
Mailing Address - Fax:
Practice Address - Street 1:818 W NAVASOTA ST
Practice Address - Street 2:
Practice Address - City:GROESBECK
Practice Address - State:TX
Practice Address - Zip Code:76642-1636
Practice Address - Country:US
Practice Address - Phone:254-707-0990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1177371363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health