Provider Demographics
NPI:1265066468
Name:CUELLAR, STEVAN (NP-C)
Entity type:Individual
Prefix:
First Name:STEVAN
Middle Name:
Last Name:CUELLAR
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 FM 983
Mailing Address - Street 2:
Mailing Address - City:FERRIS
Mailing Address - State:TX
Mailing Address - Zip Code:75125-9117
Mailing Address - Country:US
Mailing Address - Phone:972-978-0627
Mailing Address - Fax:
Practice Address - Street 1:515 W MAIN ST STE 115
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-8057
Practice Address - Country:US
Practice Address - Phone:214-491-4191
Practice Address - Fax:469-519-0407
Is Sole Proprietor?:No
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141177363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF03190044OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS
TXAP141177OtherTEXAS BOARD OF NURSING