Provider Demographics
NPI:1093142697
Name:MONTES, STACEY MELISSA (NP)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:MELISSA
Last Name:MONTES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 28953
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-8953
Mailing Address - Country:US
Mailing Address - Phone:559-299-7700
Mailing Address - Fax:
Practice Address - Street 1:729 N MEDICAL CTR DR WEST
Practice Address - Street 2:SUITE 205
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611
Practice Address - Country:US
Practice Address - Phone:559-299-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-27
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16036363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner