Provider Demographics
NPI:1457919649
Name:PANICKER, STEPHANIE (NP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:PANICKER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:341 WHEATFIELD DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:TX
Mailing Address - Zip Code:75182-4639
Mailing Address - Country:US
Mailing Address - Phone:972-329-1996
Mailing Address - Fax:972-329-0211
Practice Address - Street 1:499 S HIGHWAY 78 STE 100
Practice Address - Street 2:
Practice Address - City:WYLIE
Practice Address - State:TX
Practice Address - Zip Code:75098-3981
Practice Address - Country:US
Practice Address - Phone:469-495-9138
Practice Address - Fax:469-495-0738
Is Sole Proprietor?:No
Enumeration Date:2019-06-03
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXAP140687363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily