Healthcare Provider Details

I. General information

NPI: 1992743892
Provider Name (Legal Business Name): STACEY B MOLINERE F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 OPELOUSAS ST
LAKE CHARLES LA
70601-2641
US

IV. Provider business mailing address

2000 OPELOUSAS ST
LAKE CHARLES LA
70601-2641
US

V. Phone/Fax

Practice location:
  • Phone: 337-439-9983
  • Fax: 337-497-2556
Mailing address:
  • Phone: 337-439-9983
  • Fax: 337-497-2556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP03857
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP03857
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: