Provider Demographics
NPI:1396721213
Name:STOREY, NANCY L (RN-FNP)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:L
Last Name:STOREY
Suffix:
Gender:F
Credentials:RN-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 REALTOR AVE
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-1020
Mailing Address - Country:US
Mailing Address - Phone:870-779-2749
Mailing Address - Fax:870-779-2740
Practice Address - Street 1:910 REALTOR AVE
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-1020
Practice Address - Country:US
Practice Address - Phone:870-779-2749
Practice Address - Fax:870-779-2740
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX564395363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX173821302Medicaid
TX173821301Medicaid
TXQ6160Medicare UPIN
TX8D6049Medicare ID - Type Unspecified
TX173821301Medicaid