Provider Demographics
NPI:1710245444
Name:DAVIDSON, STACY LYNN (CRNP)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:LYNN
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1940 STONEGATE DR
Mailing Address - Street 2:STE 130
Mailing Address - City:VESTAVIA HLS
Mailing Address - State:AL
Mailing Address - Zip Code:35242-2541
Mailing Address - Country:US
Mailing Address - Phone:205-977-9876
Mailing Address - Fax:205-977-9976
Practice Address - Street 1:7300 HALCYON SUMMIT DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-3699
Practice Address - Country:US
Practice Address - Phone:205-977-9876
Practice Address - Fax:205-977-9976
Is Sole Proprietor?:No
Enumeration Date:2012-05-01
Last Update Date:2018-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-085135363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily