Provider Demographics
NPI:1730437260
Name:STICE, JAMIE RENEE (NP)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:RENEE
Last Name:STICE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1917 30TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79411-1803
Mailing Address - Country:US
Mailing Address - Phone:806-786-6258
Mailing Address - Fax:
Practice Address - Street 1:6405 107TH ST STE 200
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-8210
Practice Address - Country:US
Practice Address - Phone:806-878-0254
Practice Address - Fax:806-553-6291
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX694160TX363LF0000X
TXAP122254363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily