Provider Demographics
NPI:1740364355
Name:STALEY, JUDY (NP)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:STALEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 GREENWAY PLZ STE 2950
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77046-0924
Mailing Address - Country:US
Mailing Address - Phone:713-580-9463
Mailing Address - Fax:713-358-4819
Practice Address - Street 1:130 SAWDUST RD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77380-2272
Practice Address - Country:US
Practice Address - Phone:281-419-3162
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2008-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041164136363L00000X
TX450504363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner