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General NPI Number Information
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NPI Number | 1912231861
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Entity Type | Individual
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Provider Name | STACY LYNNE PARKER PA-C
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Gender | Male
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Dates
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Enumeration Date | 09/24/2009
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Last Update Date | 02/20/2020
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Provider Practice Location Address
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Address Line | 2110 W SLAUGHTER LN STE 185
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City | AUSTIN
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State | TX
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Zip | 78748-5992
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Country | US
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Telephone | 512-647-6049
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Fax | 361-413-0274
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Provider Business Mailing Address
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Address Line | 277 BUDDY GANEM DR STE A
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City | PORTLAND
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State | TX
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Zip | 78374-3202
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Country | US
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Telephone | 361-777-3900
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Fax | 361-413-0274
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA06892
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License Number State | TX
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