Provider Demographics
NPI:1558493890
Name:LABARRE-POWELL, STACEY D (FNP)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:D
Last Name:LABARRE-POWELL
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 1:4344 OLD FOREST RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-3064
Mailing Address - Country:US
Mailing Address - Phone:901-755-4155
Mailing Address - Fax:
Practice Address - Street 1:4344 OLD FOREST RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-3064
Practice Address - Country:US
Practice Address - Phone:901-766-1660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000006026363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily