Provider Demographics
NPI:1407191554
Name:PALMER, STACEY JANELLE (FNP)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:JANELLE
Last Name:PALMER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6010 BALCONES DR
Mailing Address - Street 2:STE 102
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4270
Mailing Address - Country:US
Mailing Address - Phone:512-323-5362
Mailing Address - Fax:
Practice Address - Street 1:6010 BALCONES DR
Practice Address - Street 2:STE 102
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4270
Practice Address - Country:US
Practice Address - Phone:512-323-5362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-30
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX670846363LF0000X
TXAP122544363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily