Provider Demographics
NPI:1912217472
Name:STACY, ANNETTE LALLANDE (APRN, FNP-C, PMHNP-B)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:LALLANDE
Last Name:STACY
Suffix:
Gender:F
Credentials:APRN, FNP-C, PMHNP-B
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 W ILLINOIS AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-6536
Mailing Address - Country:US
Mailing Address - Phone:432-999-7140
Mailing Address - Fax:
Practice Address - Street 1:1403 W ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-6536
Practice Address - Country:US
Practice Address - Phone:432-999-7140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-18
Last Update Date:2025-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP119541363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health