Provider Demographics
NPI:1255730107
Name:STARK, SONYA PRINCE (FNP-C)
Entity type:Individual
Prefix:
First Name:SONYA
Middle Name:PRINCE
Last Name:STARK
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:SONYA
Other - Middle Name:R
Other - Last Name:PRINCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:19 HUNNINGTON DR
Mailing Address - Street 2:
Mailing Address - City:NEW BOSTON
Mailing Address - State:TX
Mailing Address - Zip Code:75570-5408
Mailing Address - Country:US
Mailing Address - Phone:903-277-7196
Mailing Address - Fax:
Practice Address - Street 1:3515 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-0711
Practice Address - Country:US
Practice Address - Phone:903-791-9355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-16
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP125833363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily