Provider Demographics
NPI:1538139761
Name:HOUSTON, STACEY L (MD)
Entity Type:Individual
Prefix:DR
First Name:STACEY
Middle Name:L
Last Name:HOUSTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:STACEY
Other - Middle Name:L
Other - Last Name:FLEEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6041 VILLAGE DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-5774
Mailing Address - Country:US
Mailing Address - Phone:402-423-1900
Mailing Address - Fax:402-423-5991
Practice Address - Street 1:6041 VILLAGE DR
Practice Address - Street 2:SUITE 150
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-5774
Practice Address - Country:US
Practice Address - Phone:402-423-1900
Practice Address - Fax:402-423-5991
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE22488208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47081021213Medicaid