Provider Demographics
NPI:1548026099
Name:HERNANDEZ, STACY JUNE (AANPCB)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:JUNE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:AANPCB
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:J
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4705 BRIARWOOD AVENUE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-2639
Mailing Address - Country:US
Mailing Address - Phone:432-505-4145
Mailing Address - Fax:833-941-0864
Practice Address - Street 1:4705 BRIARWOOD AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-2639
Practice Address - Country:US
Practice Address - Phone:432-505-4145
Practice Address - Fax:833-941-0864
Is Sole Proprietor?:No
Enumeration Date:2024-02-22
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1152391363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily