MEDICARE: JAMIE RENEE STICE NP

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	363LF0000X	Family Nurse Practitioner	694160TX	TX
2	363LF0000X	Family Nurse Practitioner	AP122254	TX

General Provider Information

NPI Number	:	1730437260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE RENEE STICE NP

Provider Business Mailing Address
First Line	:	1917 30TH ST
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79411-1803
Country	:	US
Telephone Number	:	806-786-6258
Fax Number	:

Provider Business Practice Location Address
First Line	:	6405 107TH ST STE 200
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79424-8210
Country	:	US
Telephone Number	:	806-878-0254
Fax Number	:	806-553-6291

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

Provider Enumeration Date	:	08/15/2012
Last Update Date	:	12/06/2023

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