Individual
STACEY RENE COLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NNP
Contact information
Practice address
1541 KINGS HWY, SHREVEPORT, LA 71103-4228
(318) 626-0000
Mailing address
1512 W KIRBY PL, SHREVEPORT, LA 71103-3822
(318) 626-0287
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
212544
LA
363L00000X
Nurse Practitioner
4704396622
MI
363L00000X
Nurse Practitioner
AP121002
TX
363LN0000X
Neonatal Nurse Practitioner
212544
LA
363LN0000X
Neonatal Nurse Practitioner
AP121002
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
323879203
—
TX
Enumeration date
11/18/2011
Last updated
07/15/2024
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