Healthcare Provider Details

I. General information

NPI: 1376467761
Provider Name (Legal Business Name): STACY BESSERUD
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N TEXAS AVE STE C
WEBSTER TX
77598-4961
US

IV. Provider business mailing address

400 N TEXAS AVE STE C
WEBSTER TX
77598-4961
US

V. Phone/Fax

Practice location:
  • Phone: 713-732-4326
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number99645
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: