Healthcare Provider Details

I. General information

NPI: 1154674935
Provider Name (Legal Business Name): STEPHANIE NICOLE LUCIO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2012
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

602 INDIANA AVE
LUBBOCK TX
79415-3364
US

IV. Provider business mailing address

5219 CITY BANK PKWY STE 35
LUBBOCK TX
79407-3545
US

V. Phone/Fax

Practice location:
  • Phone: 806-761-0566
  • Fax: 806-744-7252
Mailing address:
  • Phone: 806-761-0333
  • Fax: 806-785-7685

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP122630
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: