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General NPI Number Information
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NPI Number | 1992030928
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Entity Type | Individual
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Provider Name | STACY LYNN NP
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Gender | Female
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Dates
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Enumeration Date | 10/08/2009
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Last Update Date | 09/01/2025
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Provider Practice Location Address
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Address Line | 492 DANTE VILLA ST
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City | HENDERSON
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State | NV
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Zip | 89011-5689
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Country | US
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Telephone | 208-251-2524
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Fax |
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Provider Business Mailing Address
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Address Line | 492 DANTE VILLA ST
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City | HENDERSON
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State | NV
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Zip | 89011-5689
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Country | US
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Telephone | 208-251-2524
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN002018
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP-935A
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License Number State | ID
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