Provider Demographics
NPI:1568547818
Name:IVEY, NENA R (PA-C)
Entity Type:Individual
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First Name:NENA
Middle Name:R
Last Name:IVEY
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:4800 NE STALLINGS DR
Mailing Address - Street 2:STE 109
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-1250
Mailing Address - Country:US
Mailing Address - Phone:936-559-8770
Mailing Address - Fax:936-559-8773
Practice Address - Street 1:4604 NE STALLINGS DR
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75965-1608
Practice Address - Country:US
Practice Address - Phone:936-559-8770
Practice Address - Fax:936-559-8773
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2022-05-05
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Provider Licenses
StateLicense IDTaxonomies
TX363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical