Provider Demographics
NPI:1659651016
Name:WHITE, STACEY SUE (FNP-C)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:SUE
Last Name:WHITE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:
Other - Last Name:POWELL-SMITH; POWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:255 UNION BLVD SUITE 120
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1833
Mailing Address - Country:US
Mailing Address - Phone:303-936-7415
Mailing Address - Fax:303-936-2177
Practice Address - Street 1:255 UNION BLVD SUITE 120
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1833
Practice Address - Country:US
Practice Address - Phone:303-936-7415
Practice Address - Fax:303-936-2177
Is Sole Proprietor?:No
Enumeration Date:2011-08-17
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0990161-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO432856306OtherPASSPORT