Individual
LACY R STARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1307 8TH AVE, SUITE 608, FORT WORTH, TX 76104-4140
(817) 921-4191
(817) 429-7783
Mailing address
1307 8TH AVE, SUITE 608, FORT WORTH, TX 76104-4140
(817) 921-4191
(817) 429-7783
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP135511
TX
Other
Enumeration date
10/26/2017
Last updated
04/29/2024
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