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General NPI Number Information
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NPI Number | 1205258753
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Entity Type | Individual
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Provider Name | STACY NICOLE BRATCHER FNP-C
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Gender | Female
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Dates
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Enumeration Date | 01/16/2014
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Last Update Date | 01/24/2024
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Provider Practice Location Address
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Address Line | 4002 TECHNOLOGY CTR
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City | LONGVIEW
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State | TX
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Zip | 75605-2697
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Country | US
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Telephone | 903-247-0484
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Fax | 903-247-0485
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Provider Business Mailing Address
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Address Line | 4025 E SOUTHCROSS BLVD
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City | SAN ANTONIO
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State | TX
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Zip | 78222-3641
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Country | US
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Telephone | 210-333-1255
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Fax | 210-333-8496
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 749768
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 749768
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License Number State | TX
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