Individual
STACEY PENICK STANDRIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1000 OCHSNER BLVD, COVINGTON, LA 70433
(985) 871-0095
(985) 871-0529
Mailing address
1514 JEFFERSON HWY, NEW ORLEANS, LA 70121-2429
(504) 842-4000
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
105551-6626
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00172269
—
MS
05
—
2175718
—
LA
Enumeration date
10/10/2011
Last updated
10/26/2016
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