Individual
STACI A PAVELKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
6704 STERLING RIDGE DR STE A, THE WOODLANDS, TX 77382-2329
(281) 210-1200
(281) 210-1210
Mailing address
6704 STERLING RIDGE DR STE A, THE WOODLANDS, TX 77382-2329
(281) 210-1200
(281) 210-1210
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
647281
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00J21A
GROUP MEDICARE
TX
01
—
094010801
GROUP MEDICAID
TX
Enumeration date
10/05/2006
Last updated
09/24/2009
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