Healthcare Provider Details

I. General information

NPI: 1508147679
Provider Name (Legal Business Name): STACEY KAY YEPES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STACEY KAY BURNELL

II. Dates (important events)

Enumeration Date: 09/02/2011
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 W. COLORADO BLVD. PAVILION II SUITE 831
DALLAS TX
75208
US

IV. Provider business mailing address

221 W. COLORADO BLVD. PAVILION II SUITE 831
DALLAS TX
75208
US

V. Phone/Fax

Practice location:
  • Phone: 214-933-7430
  • Fax: 214-947-8609
Mailing address:
  • Phone: 214-933-7430
  • Fax: 214-947-8609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP119018
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: