Healthcare Provider Details

I. General information

NPI: 1962367672
Provider Name (Legal Business Name): STACIE A WOKOECK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STACIE A ROUTON

II. Dates (important events)

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

III. Provider practice location address

2700 COMMERCE WAY STE 400
KAUFMAN TX
75142-7362
US

IV. Provider business mailing address

2220 H G MOSLEY PKWY
LONGVIEW TX
75604-3663
US

V. Phone/Fax

Practice location:
  • Phone: 469-804-6153
  • Fax: 317-334-7336
Mailing address:
  • Phone: 903-353-9247
  • Fax: 317-334-7336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-292758
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: