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General NPI Number Information
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NPI Number | 1245021120
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Entity Type | Individual
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Provider Name | STACIE G CARLOCK DNP, APRN, NNP-BC
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Gender | Female
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Dates
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Enumeration Date | 05/13/2025
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Last Update Date | 07/25/2025
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Provider Practice Location Address
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Address Line | 800 E DAWSON ST
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City | TYLER
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State | TX
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Zip | 75701-2036
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Country | US
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Telephone | 36-061-7219
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Fax |
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Provider Business Mailing Address
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Address Line | 3213 SUNSET DR
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City | SAN ANGELO
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State | TX
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Zip | 76904-6042
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Country | US
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Telephone | 575-200-5424
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Fax |
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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 | 363LN0000X
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Taxonomy Name | Neonatal Nurse Practitioner
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License Number | 1205776
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License Number State | TX
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