Provider Demographics
NPI:1740743939
Name:ALDRIDGE, STACEY REBECCA (FNP-C)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:REBECCA
Last Name:ALDRIDGE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:784 MARSALIS DR
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79603-5519
Mailing Address - Country:US
Mailing Address - Phone:325-669-5968
Mailing Address - Fax:
Practice Address - Street 1:784 MARSALIS DR
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79603-5519
Practice Address - Country:US
Practice Address - Phone:325-669-5968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141347363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1740743939OtherNPI
TX1740743939OtherBON
TXAP141347OtherLICENSE NUMBER