Stacie Leah Pruett, FNP
Individual provider Active NPI Family Nurse Practitioner · Peculiar, MO
NPI 1003546789 · NPPES record last updated Jun 15, 2022
Key facts
- NPI
- 1003546789
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 2022021022 (MO)
- Practice address
- 24221 S Rockhaven Rd
Peculiar, MO 64078-9679 - Phone
- (816) 308-5877
- NPI assigned
- Jun 15, 2022
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Geriatric Primary Care PA
Practice addresses (Care Compare)
12500 W 137TH St
Overland Park, KS 66221-4129
Phone (913) 730-3700
Hospital & facility affiliations
- Bates County Memorial Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230209000954 | KS | Practitioner - Nurse Practitioner | 4688046154 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2022021022 | MO | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Geriatric Primary Care PA | Current |
Accepting new patients | |
| Signify Health Medical Associates of Kansas LLC | Current |
Accepting new patients |
Locations
12120 State Line Rd
Leawood, KS 66209
Phone (913) 302-7183
4055 Valley View Ln
Ste 400
Dallas, TX 75244
Phone (469) 466-7037
Interoperability endpoints
- https://api.platform.athenahealth.com/15058/brand/2/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 2022021022 | MO | Yes |
Addresses
Primary practice location
24221 S Rockhaven Rd
Peculiar, MO 64078-9679
Mailing address
24221 S Rockhaven Rd
Peculiar, MO 64078-9679
Phone (816) 308-5877
Other providers in Peculiar, MO
- Peculiar Family Chiropractic & Sports Medicine,
- Peculiar Medical Clinic
- Peculiar Pharmacy LLC
- Lucinda Pennington
- Sheryl Lynn Phillips
- Psylin, Inc.
- Raymore-Peculiar Reorganized School
- Emma Jane Rewerts
- Rummerfield Chiropractic LLC
- Kenneth W Rummerfield
All providers in Peculiar, MO · Family Nurse Practitioner in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 15, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.