Provider Demographics
NPI:1265742373
Name:KEMNADE, STACI MARIE (RN, ACNP-BC)
Entity type:Individual
Prefix:
First Name:STACI
Middle Name:MARIE
Last Name:KEMNADE
Suffix:
Gender:F
Credentials:RN, ACNP-BC
Other - Prefix:
Other - First Name:STACI
Other - Middle Name:ARNOLD
Other - Last Name:SMALLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, ACNP-BC
Mailing Address - Street 1:6720 BERTNER ST
Mailing Address - Street 2:MC 4-278, BOX 112
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2604
Mailing Address - Country:US
Mailing Address - Phone:832-355-3482
Mailing Address - Fax:832-355-6865
Practice Address - Street 1:6720 BERTNER ST
Practice Address - Street 2:MC 4-278, BOX 112
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2604
Practice Address - Country:US
Practice Address - Phone:832-355-3487
Practice Address - Fax:832-355-6865
Is Sole Proprietor?:No
Enumeration Date:2010-10-08
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX712481363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB115625Medicare PIN
TXTXB115624Medicare PIN