Provider Demographics
NPI:1558320697
Name:STARK, PATRICIA CALDWELL (RN ANP)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:CALDWELL
Last Name:STARK
Suffix:
Gender:F
Credentials:RN ANP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 848476
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-8476
Mailing Address - Country:US
Mailing Address - Phone:254-202-4655
Mailing Address - Fax:254-202-4697
Practice Address - Street 1:1001 HEWITT DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-8486
Practice Address - Country:US
Practice Address - Phone:254-202-7800
Practice Address - Fax:254-202-7856
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX445849207Q00000X
TXAP107316363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX38053701Medicaid
TX80N899OtherBCBS
500011430Medicare PIN
TX38053701Medicaid
80N899Medicare PIN
TX80N899OtherBCBS