Doctor Name: | STACEY WRIGHT EAVES |
NPI Number: | 1104172535 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | ACNP |
License Number: | AP07073 |
Business Practice Address: | 2300 Hospital Dr Ste. 450 Bossier City, LA - 711112394 |
Business Phone Number: | 3187522328 |
Business Fax Number: | 3187460160 |
Mailing Address: | 2300 Hospital Dr, Ste. 450 BOSSIER CITY |
State: | LA |
Postal Code: | 711112394 |
Phone Number: | 3187522328 |
Fax Number: | 3187460160 |
NPI Enumeration Date: | 08/03/2012 |
NPI Last Update Date: | 01/06/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LA2100X |
License Number: | AP07073 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | LA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Acute Care |
Taxonomy Definition: |