| NPI | 1407191323 |
|---|---|
| Former Name | STACI DICKARD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: TX AP122615) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: TX 755740) |
| 363LP2300X Nurse Practitioner, Primary Care (Licence: TX AP122615) | |
| Enumeration Date | 2012-12-04 |
| Last Update Date | 2024-05-14 |