MEDICARE: STACEY L PREVOST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)		TX

General Provider Information

NPI Number	:	1184556755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY L PREVOST

Provider Business Mailing Address
First Line	:	6706 DOCKENS FOREST LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77049-5503
Country	:	US
Telephone Number	:	682-337-1908
Fax Number	:

Provider Business Practice Location Address
First Line	:	6706 DOCKENS FOREST LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77049-5503
Country	:	US
Telephone Number	:	682-337-1908
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2026
Last Update Date	:	05/30/2026

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Directions to “ STACEY L PREVOST ” Practice Location

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