Individual
STACY YOHANNAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4725 WELLINGTON ST, GREENVILLE, TX 75401-4945
(469) 320-1267
(945) 242-8020
Mailing address
PO BOX 29650, DEPT# 880579, PHOENIX, AZ 85038
(480) 626-1746
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP144895
TX
363LF0000X
Family Nurse Practitioner
AP144895
TX
Other
Enumeration date
09/15/2021
Last updated
12/06/2022
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