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Individual
MRS. STACEY M SOUTH
Active
Individual
MRS. STACEY M SOUTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
616796
TX
367500000X
Certified Registered Nurse Anesthetist
Primary
AP110748
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
140480805
—
TX
05
—
140480812
—
TX
01
—
616796
TSBNE
TX
01
—
8339UG
BCBS
TX
01
—
P01446768
RR
TX
Enumeration date
08/15/2006
Last updated
06/15/2020
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