Provider Demographics
NPI:1871845115
Name:STOCK, ANTHONY (FNP-C)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:STOCK
Suffix:
Gender:M
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 1:17189 INTERSTATE 45 S STE 175
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77385-3323
Mailing Address - Country:US
Mailing Address - Phone:936-270-4200
Mailing Address - Fax:
Practice Address - Street 1:17189 INTERSTATE 45 S STE 175
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77385-3323
Practice Address - Country:US
Practice Address - Phone:936-270-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-10
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX771712363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily