Individual
KENNETH W STACKHOUSE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
F.N.P.
Contact information
Practice address
2606 HOSPITAL BLVD, CORPUS CHRISTI, TX 78405-1804
(361) 902-4000
Mailing address
1717 MAIN ST, SUITE 5200, DALLAS, TX 75201-4612
(214) 712-2000
(214) 712-2444
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
607067
TX
Other
Enumeration date
05/29/2009
Last updated
05/29/2009
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