Provider Demographics
NPI:1619240850
Name:PARRY, STACEY RENEE (RN)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:RENEE
Last Name:PARRY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8739 BANDERA RD STE 103-108
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78250-2506
Mailing Address - Country:US
Mailing Address - Phone:210-888-0105
Mailing Address - Fax:888-523-1116
Practice Address - Street 1:8739 BANDERA RD STE 103-108
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78250-2506
Practice Address - Country:US
Practice Address - Phone:210-888-0105
Practice Address - Fax:888-523-1116
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-20
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX770931163W00000X, 163WC0400X, 163WH1000X, 163WC1600X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WH1000XNursing Service ProvidersRegistered NurseHospice
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development
No163WH0200XNursing Service ProvidersRegistered NurseHome Health