Provider Demographics
NPI:1508147679
Name:YEPES, STACEY KAY (NP)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:KAY
Last Name:YEPES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:KAY
Other - Last Name:BURNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7777 FOREST LN
Mailing Address - Street 2:SUITE C339
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2571
Mailing Address - Country:US
Mailing Address - Phone:972-566-8855
Mailing Address - Fax:972-566-7509
Practice Address - Street 1:7777 FOREST LN
Practice Address - Street 2:SUITE C339
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2571
Practice Address - Country:US
Practice Address - Phone:972-566-8855
Practice Address - Fax:972-566-7509
Is Sole Proprietor?:No
Enumeration Date:2011-09-02
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX652550363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB157027Medicare UPIN