Provider Demographics
NPI:1942672928
Name:STENNETT, NICOLE LEANN (MPAS, PA-C)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:LEANN
Last Name:STENNETT
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Gender:F
Credentials:MPAS, PA-C
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Mailing Address - Street 1:8141 DORADO DR
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79765-8533
Mailing Address - Country:US
Mailing Address - Phone:432-563-3113
Mailing Address - Fax:432-563-4206
Practice Address - Street 1:8141 DORADO DR
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79765-8533
Practice Address - Country:US
Practice Address - Phone:432-563-3113
Practice Address - Fax:432-563-4206
Is Sole Proprietor?:No
Enumeration Date:2015-10-29
Last Update Date:2020-02-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
363A00000X
TXPA10214363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant