Provider Demographics
NPI:1871721597
Name:NORRIS, STEPHANIE PAIGE BRISCOE (FNP-C)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:PAIGE BRISCOE
Last Name:NORRIS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 E RENFRO ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-3947
Mailing Address - Country:US
Mailing Address - Phone:817-295-3100
Mailing Address - Fax:817-295-3158
Practice Address - Street 1:312 E RENFRO ST
Practice Address - Street 2:SUITE 101
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-3947
Practice Address - Country:US
Practice Address - Phone:817-295-3100
Practice Address - Fax:817-295-3158
Is Sole Proprietor?:No
Enumeration Date:2009-07-01
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX695907363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX282401303Medicaid
TX282401302Medicaid
TX282401302Medicaid
TXTXB130246Medicare PIN
TXTXB130245Medicare PIN