Healthcare Provider Details

I. General information

NPI: 1720853450
Provider Name (Legal Business Name): STACY ANDERSEN PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STACY ANDERSEN APRN, PMHNP-BC

II. Dates (important events)

Enumeration Date: 11/22/2023
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 MILL STREET NONE
RENO NV
89502
US

IV. Provider business mailing address

1730 TRAIL CREEK WAY
RENO NV
89523-4888
US

V. Phone/Fax

Practice location:
  • Phone: 775-982-8988
  • Fax:
Mailing address:
  • Phone: 530-414-5070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number906531
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28555
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number514568
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: