Provider Demographics
NPI:1558601880
Name:NELSON, STEPHANIE RENEE (FNP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:RENEE
Last Name:NELSON
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 1:2121 E GRIFFIN PKWY
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-3241
Mailing Address - Country:US
Mailing Address - Phone:956-584-8111
Mailing Address - Fax:956-580-1585
Practice Address - Street 1:2121 E GRIFFIN PKWY
Practice Address - Street 2:SUITE 5
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-3241
Practice Address - Country:US
Practice Address - Phone:956-584-8111
Practice Address - Fax:956-580-1585
Is Sole Proprietor?:No
Enumeration Date:2013-02-23
Last Update Date:2013-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX697842363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily