Provider Demographics
NPI:1851561526
Name:LUND, STACY (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:
Last Name:LUND
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20639 KUYKENDAHL RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-3587
Mailing Address - Country:US
Mailing Address - Phone:832-698-0111
Mailing Address - Fax:
Practice Address - Street 1:20639 KUYKENDAHL RD STE 200
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379
Practice Address - Country:US
Practice Address - Phone:832-698-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-09
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02511363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant