Provider Demographics
NPI:1932377538
Name:ADAMS, STACEY LEIGH (ACNP)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:LEIGH
Last Name:ADAMS
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11040 VISTA DEL SOL DR STE C
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-4314
Mailing Address - Country:US
Mailing Address - Phone:915-591-7704
Mailing Address - Fax:915-591-7734
Practice Address - Street 1:2030 N MESA ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-3310
Practice Address - Country:US
Practice Address - Phone:915-532-7100
Practice Address - Fax:915-351-0601
Is Sole Proprietor?:No
Enumeration Date:2008-02-15
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX657277363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX193002603Medicaid
NM77532546Medicaid
NM77532546Medicaid