Provider Demographics
NPI:1770511107
Name:DURR, STACEY VAUGHN (RN, CFNP)
Entity Type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:VAUGHN
Last Name:DURR
Suffix:
Gender:F
Credentials:RN, CFNP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1800 BUCKNER ST
Mailing Address - Street 2:SUITE C120
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4440
Mailing Address - Country:US
Mailing Address - Phone:318-227-8899
Mailing Address - Fax:318-220-9794
Practice Address - Street 1:1800 BUCKNER ST
Practice Address - Street 2:SUITE C120
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4440
Practice Address - Country:US
Practice Address - Phone:318-227-8899
Practice Address - Fax:318-220-9794
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAAP04792 RN060254363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1584355Medicaid
LAP00287941OtherRAILROAD MEDICARE NUMBER
LA1584355Medicaid