Provider Demographics
NPI:1932377538
Name:ADAMS, STACEY LEIGH (ACNP)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:LEIGH
Last Name:ADAMS
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11040 VISTA DEL SOL DR STE C
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-4314
Mailing Address - Country:US
Mailing Address - Phone:915-591-7704
Mailing Address - Fax:915-591-7734
Practice Address - Street 1:3051 N ZARAGOZA RD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-7921
Practice Address - Country:US
Practice Address - Phone:915-401-8019
Practice Address - Fax:915-401-8096
Is Sole Proprietor?:No
Enumeration Date:2008-02-15
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX657277363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM77532546Medicaid
TX193002603Medicaid
NM77532546Medicaid