Provider Demographics
NPI:1710790050
Name:BONHAM-PALAS, STACEY (DNP, AGACNP)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:
Last Name:BONHAM-PALAS
Suffix:
Gender:F
Credentials:DNP, AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7507 PAR VIEW CV
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-8301
Mailing Address - Country:US
Mailing Address - Phone:212-203-5855
Mailing Address - Fax:
Practice Address - Street 1:6025 WALNUT GROVE RD STE 111
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2102
Practice Address - Country:US
Practice Address - Phone:901-271-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN63826363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care