Healthcare Provider Details

I. General information

NPI: 1013462274
Provider Name (Legal Business Name): STACY ANN OLVERA N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2016
Last Update Date: 07/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1316 N YARBROUGH DR STE 1A
EL PASO TX
79925-7814
US

IV. Provider business mailing address

14470 HORIZON BLVD STE J
HORIZON CITY TX
79928-7696
US

V. Phone/Fax

Practice location:
  • Phone: 915-772-5400
  • Fax: 915-772-5402
Mailing address:
  • Phone: 915-777-9075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP130951
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: