Provider Demographics
NPI:1124391420
Name:SANNES, STACEY HELEN (PA-C)
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:HELEN
Last Name:SANNES
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 1:10223 BROADWAY ST STE A
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7881
Mailing Address - Country:US
Mailing Address - Phone:713-436-3488
Mailing Address - Fax:713-436-3860
Practice Address - Street 1:10223 BROADWAY ST STE A
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-7881
Practice Address - Country:US
Practice Address - Phone:713-436-3488
Practice Address - Fax:713-436-3860
Is Sole Proprietor?:No
Enumeration Date:2012-02-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08358363AS0400X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE0198904OtherTEXAS DEPT OF PUBLIC SAFETY
TXPA08358OtherTEXAS LICENSE
TXPA08358OtherTEXAS LICENSE