MEDICARE: STACEY WHEATLEY FNP

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	363L00000X	Nurse Practitioner	AP133320	TX

General Provider Information

NPI Number	:	1629519368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACEY WHEATLEY FNP

Provider Business Mailing Address
First Line	:	1521 BAKER RD
Second Line	:
City	:	SHERMAN
State	:	TX
Zip	:	75090-2409
Country	:	US
Telephone Number	:	903-891-1972
Fax Number	:	903-892-6093

Provider Business Practice Location Address
First Line	:	1521 BAKER RD
Second Line	:
City	:	SHERMAN
State	:	TX
Zip	:	75090-2409
Country	:	US
Telephone Number	:	903-891-1972
Fax Number	:	903-892-6093

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

Provider Enumeration Date	:	03/14/2017
Last Update Date	:	04/18/2023

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