Provider Demographics
NPI:1811008592
Name:BLACHE, STEPHANIE FORD (MS, RN, CPNP)
Entity Type:Individual
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First Name:STEPHANIE
Middle Name:FORD
Last Name:BLACHE
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Gender:F
Credentials:MS, RN, CPNP
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Mailing Address - Street 1:7200 STATE HIGHWAY 161
Mailing Address - Street 2:SUITE 100
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-2804
Mailing Address - Country:US
Mailing Address - Phone:972-331-7200
Mailing Address - Fax:972-331-7201
Practice Address - Street 1:8515 GREENVILLE AVE STE N108
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-7035
Practice Address - Country:US
Practice Address - Phone:214-221-0855
Practice Address - Fax:214-221-1437
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2020-06-09
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Provider Licenses
StateLicense IDTaxonomies
TX501766363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics