Provider Demographics
NPI:1699787697
Name:STOVALL, MADY CAROL (PMHNP)
Entity type:Individual
Prefix:
First Name:MADY
Middle Name:CAROL
Last Name:STOVALL
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7810 LOUIS PASTEUR DR FL 1
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3471
Mailing Address - Country:US
Mailing Address - Phone:210-450-7222
Mailing Address - Fax:210-450-2104
Practice Address - Street 1:7810 LOUIS PASTEUR DR FL 1
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3471
Practice Address - Country:US
Practice Address - Phone:210-450-7222
Practice Address - Fax:210-450-2104
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126749363LP0808X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00NP151810Medicaid
CAWNP15181AMedicare PIN
CA00NP151810Medicaid