Provider Demographics
NPI:1366049686
Name:WALKER, STACEY MEECE
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:MEECE
Last Name:WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 WATERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:TX
Mailing Address - Zip Code:77630-8237
Mailing Address - Country:US
Mailing Address - Phone:409-790-0896
Mailing Address - Fax:409-332-4104
Practice Address - Street 1:4347 PHELAN BLVD STE 101
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77707-2159
Practice Address - Country:US
Practice Address - Phone:409-767-9285
Practice Address - Fax:409-332-4104
Is Sole Proprietor?:No
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1016287363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily