Provider Demographics
NPI:1306822978
Name:STINES, LAWRENCE CHRIS (FNP)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:CHRIS
Last Name:STINES
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 5749
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77903
Mailing Address - Country:US
Mailing Address - Phone:361-575-4100
Mailing Address - Fax:361-575-4111
Practice Address - Street 1:606 E NUECES ST
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901
Practice Address - Country:US
Practice Address - Phone:361-575-4100
Practice Address - Fax:361-575-4111
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX631688363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176123101Medicaid
TXNP7206OtherBCBS OF TX #
Q04567Medicare UPIN
TX611950Medicare ID - Type Unspecified
TX611950Medicare ID - Type Unspecified