Individual
MS. STACEY D ERVIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
3111 MCCANN RD, LONGVIEW, TX 75605-7842
(903) 753-1212
(214) 712-2487
Mailing address
370 UTAH ST, AVERY, TX 75554-2600
(903) 908-0352
(903) 798-8895
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
630620
TX
363LF0000X
Family Nurse Practitioner
AP113426
TX
Other
Enumeration date
06/14/2006
Last updated
11/07/2023
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