Provider Demographics
NPI:1356663041
Name:COLBERT, STACEY ELAINE (MSN, WHNP-BC, FNP-BC)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:ELAINE
Last Name:COLBERT
Suffix:
Gender:F
Credentials:MSN, WHNP-BC, FNP-BC
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:
Other - Last Name:PRITCHETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, WHNP-BC, FNP-BC
Mailing Address - Street 1:2994 KILDAIRE FARM RD
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-9614
Mailing Address - Country:US
Mailing Address - Phone:919-387-1075
Mailing Address - Fax:
Practice Address - Street 1:2994 KILDAIRE FARM RD
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-9614
Practice Address - Country:US
Practice Address - Phone:919-387-1075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-22
Last Update Date:2016-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5008282363LF0000X, 363LF0000X
MI4704244115363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily