Active NPI
Charlie C Stacy
- Licensed Practical Nurse
- Rootstown, OH
National Provider Identifier
1013206374
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- PN 142404
- Practice address
- 4014 Bower Rd
Rootstown, OH 44272-9231 - Phone
- (330) 325-7636
- NPI assigned
- Apr 6, 2011
- 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 |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | PN 142404 | OH | Primary |
Addresses
Primary practice location
4014 Bower Rd
Rootstown, OH 44272-9231
Mailing address
4014 Bower Rd
Rootstown, OH 44272-9231
Phone (330) 325-7636
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 |
|---|---|---|---|
| PN 142404 | OH | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1302048000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1302048000000",
"number": "1013206374",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4014 BOWER RD",
"city": "ROOTSTOWN",
"state": "OH",
"postal_code": "442729231",
"telephone_number": "330-325-7636"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4014 BOWER RD",
"city": "ROOTSTOWN",
"state": "OH",
"postal_code": "442729231",
"telephone_number": "330-325-7636"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STACY",
"first_name": "CHARLIE",
"middle_name": "C",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-04-06",
"last_updated": "2011-04-06",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "OH",
"license": "PN 142404",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rootstown, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.