Provider Demographics
NPI:1245916378
Name:HERRIN, STACEY THOMAS (FNP-C)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:THOMAS
Last Name:HERRIN
Suffix:
Gender:F
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 1:3515 PHILADELPHIA CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:NC
Mailing Address - Zip Code:28034-7560
Mailing Address - Country:US
Mailing Address - Phone:704-747-5713
Mailing Address - Fax:
Practice Address - Street 1:607 S GENERALS BLVD
Practice Address - Street 2:
Practice Address - City:LINCOLNTON
Practice Address - State:NC
Practice Address - Zip Code:28092-3658
Practice Address - Country:US
Practice Address - Phone:704-736-9188
Practice Address - Fax:704-736-9667
Is Sole Proprietor?:No
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5018297363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily