Provider Demographics
NPI:1164684254
Name:VALDESPINO, STORMY O (FNP-C, PMHNP)
Entity type:Individual
Prefix:
First Name:STORMY
Middle Name:O
Last Name:VALDESPINO
Suffix:
Gender:F
Credentials:FNP-C, PMHNP
Other - Prefix:
Other - First Name:STORMY
Other - Middle Name:
Other - Last Name:MENDOZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1200 BROOKLYN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-4815
Mailing Address - Country:US
Mailing Address - Phone:210-560-5841
Mailing Address - Fax:201-462-3853
Practice Address - Street 1:1200 BROOKLYN AVE STE 150
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-4815
Practice Address - Country:US
Practice Address - Phone:210-560-5841
Practice Address - Fax:201-462-3853
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX659602363LF0000X
TX117236363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8580MBOtherBCBS-TX
TX8580MBOtherBCBS-TX