Active NPI
Jackie Lee Stiltner
- Pharmacist
- McCarr, KY
National Provider Identifier
1003141631
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 014680
- Practice address
- 11349 State Hwy 1056 Buskirk Plaza
Rite Aid
McCarr, KY 41544 - Phone
- (606) 427-9007
- NPI assigned
- Oct 15, 2009
- Last updated
- Oct 15, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 014680 | KY | Primary |
Addresses
Primary practice location
11349 State Hwy 1056 Buskirk Plaza
Rite Aid
McCarr, KY 41544
Mailing address
13685 Grapevine Rd
Phyllis, KY 41554-8504
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 014680 | KY | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1255564800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1255564800000",
"number": "1003141631",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13685 GRAPEVINE RD",
"city": "PHYLLIS",
"state": "KY",
"postal_code": "415548504"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11349 STATE HWY 1056 BUSKIRK PLAZA",
"address_2": "RITE AID",
"city": "MCCARR",
"state": "KY",
"postal_code": "41544",
"telephone_number": "606-427-9007"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STILTNER",
"first_name": "JACKIE",
"middle_name": "LEE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-10-15",
"last_updated": "2009-10-15",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "KY",
"license": "014680",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in McCarr, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.