Provider Demographics
NPI:1326383589
Name:WEST, STACI MICHELLE (ACNP DNP)
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:MICHELLE
Last Name:WEST
Suffix:
Gender:F
Credentials:ACNP DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 N WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-3272
Mailing Address - Country:US
Mailing Address - Phone:806-786-7078
Mailing Address - Fax:575-625-8452
Practice Address - Street 1:1621 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-3272
Practice Address - Country:US
Practice Address - Phone:806-786-7078
Practice Address - Fax:575-625-8452
Is Sole Proprietor?:No
Enumeration Date:2012-11-29
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP02096363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care