Provider Demographics
NPI:1851487821
Name:PAVELKA, STACI A (FNP)
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:A
Last Name:PAVELKA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:STACI
Other - Middle Name:A
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6704 STERLING RIDGE DR STE A
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77382-2329
Mailing Address - Country:US
Mailing Address - Phone:281-210-1200
Mailing Address - Fax:281-210-1210
Practice Address - Street 1:6704 STERLING RIDGE DR STE A
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77382-2329
Practice Address - Country:US
Practice Address - Phone:281-210-1200
Practice Address - Fax:281-210-1210
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX647281363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00J21AOtherGROUP MEDICARE
TX094010801OtherGROUP MEDICAID