Provider Demographics
NPI:1245670314
Name:SPEARS, STACEY HECKFORD (FNP)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:HECKFORD
Last Name:SPEARS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:LYNN
Other - Last Name:HECKFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:613 NORTHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-1684
Mailing Address - Country:US
Mailing Address - Phone:318-547-9242
Mailing Address - Fax:
Practice Address - Street 1:1200 S FARMERVILLE ST
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-5941
Practice Address - Country:US
Practice Address - Phone:318-255-3690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-03
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07368363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily