Provider Demographics
NPI:1932532637
Name:EFFERSON, STACY N (NP)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:N
Last Name:EFFERSON
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 1:1101 MEDICAL CENTER BLVD.
Mailing Address - Street 2:ER
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072
Mailing Address - Country:US
Mailing Address - Phone:504-349-1533
Mailing Address - Fax:504-349-1530
Practice Address - Street 1:1101 MEDICAL CENTER BLVD.
Practice Address - Street 2:ER
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072
Practice Address - Country:US
Practice Address - Phone:504-349-1533
Practice Address - Fax:504-349-1530
Is Sole Proprietor?:No
Enumeration Date:2013-08-16
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07489363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAAP07489OtherAPRN LICENSE