Stacey Deann Clark, is a
Licensed Vocational Nurse based in Axtell, Texas. Stacey Deann Clark is licensed to practice in Texas (license number 347556) and her current practice location is
1400 Barron Ln, Axtell, Texas. She can be reached at her office (for appointments etc.) via phone at
(770) 255-8982.
NPI number for Stacey Deann Clark is 1134686124 and her current mailing address is 1400 Barron Ln, Axtell, Texas. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1134686124.
Provider's Profile
| Full Name | Stacey Deann Clark |
|---|
| Gender | Female |
|---|
| Speciality | Licensed Vocational Nurse |
|---|
| Location | 1400 Barron Ln, Axtell, Texas |
|---|
| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
|---|
NPI Data:
- NPI Number: 1134686124
- Provider Enumeration Date: 02/26/2019
- Last Update Date: 02/26/2019
Medical Identifiers
Medical identifiers for Stacey Deann Clark such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1134686124 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 164X00000X | Licensed Vocational Nurse | 347556 (Texas) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Stacey Deann Clark is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Stacey Deann Clark,
1400 Barron Ln,
Axtell, TX 76624-1394
Ph: (770) 255-8982 | Stacey Deann Clark,
1400 Barron Ln,
Axtell, TX 76624-1394
Ph: (770) 255-8982 |
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