Basic Information
| Provider Information | |||||||||
| NPI: | 1609933985 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARR | ||||||||
| FirstName: | STACY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 907 EUREKA ST | ||||||||
| Address2: | SUITE B | ||||||||
| City: | WEATHERFORD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760865880 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8175994901 | ||||||||
| FaxNumber: | 3256469964 | ||||||||
| Practice Location | |||||||||
| Address1: | 907 EUREKA ST | ||||||||
| Address2: | SUITE B | ||||||||
| City: | WEATHERFORD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 760865880 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8175994901 | ||||||||
| FaxNumber: | 3256469454 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2007 | ||||||||
| LastUpdateDate: | 09/08/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA04567 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.