Provider Demographics
NPI:1457728735
Name:MCCOWN, STACY R (FNP)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:R
Last Name:MCCOWN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 S RAGSDALE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75766-2434
Mailing Address - Country:US
Mailing Address - Phone:903-541-5000
Mailing Address - Fax:903-589-1113
Practice Address - Street 1:2000 E LAMAR BLVD STE 150
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76006-7337
Practice Address - Country:US
Practice Address - Phone:830-406-6367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-21
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX736403363LF0000X
TXAP128890363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily