Stacey M Anderson, APRN
Individual provider Active NPI Nurse Practitioner · Lexington, KY
NPI 1013300896 · NPPES record last updated Dec 2, 2024
Key facts
- NPI
- 1013300896
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 3009247 (KY)
- Practice address
- 1225 S Broadway Ste 201
Lexington, KY 40504-2701 - Phone
- (859) 258-4950
- Fax
- (859) 258-4618
- NPI assigned
- Mar 18, 2015
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 11
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Clark Regional Physician Practices LLC
Practice addresses (Care Compare)
8 Linville Dr
Paris, KY 40361-2170
Phone (859) 737-4411
Hospital & facility affiliations
- Clark Regional Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
- 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 |
|---|---|---|---|---|
| I20150511002525 | KY | Practitioner - Nurse Practitioner | 6800115916 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3009247 | KY | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bourbon Physician Practice LLC | Current |
Accepting new patients | |
| Bourbon Physician Practice LLC | Family | Current | Accepting new patients |
| Meadowview Physician Practice LLC | Current |
Accepting new patients | |
| Bourbon Physician Practice LLC | Family | Current |
Accepting new patients |
| Clark Regional Physician Practices LLC | Current |
Accepting new patients | |
| Meadowview Physician Practice LLC | Nurse Practitioner | Current |
Accepting new patients |
| Meadowview Physician Practice, LLC | Nurse Practitioner | Current | Accepting new patients |
| Clark Regional Physician Practices, LLC | Nurse Practitioner | Current |
Accepting new patients |
| Kentucky Hospital, LLC | Past | Accepting new patients |
Locations
107 S Broadway St
Carlisle, KY 40311
Phone (606) 289-4124
1210 KY Highway 36 E
Cynthiana, KY 41031
Phone (859) 234-2300
732 Elizaville Ave
Flemingsburg, KY 41041
Phone (606) 849-2323
991 Medical Park Dr
Ste 201
Maysville, KY 41056
Phone (606) 759-3585
991 Medical Park Dr
Ste 202
Maysville, KY 41056
Phone (606) 759-5424
8 Linville Dr
Paris, KY 40361
Phone (859) 321-8631
22 Clinic Dr
Paris, KY 40361
Phone (859) 987-0074
225 Hospital Dr
Ste 315
Winchester, KY 40391
Phone (859) 737-6488
225 Hospital Dr
Winchester, KY 40391
Phone (859) 737-8528
225 Hospital Dr
Ste 200A
Winchester, KY 40391
Phone (859) 737-6480
455 Bullion Blvd
Winchester, KY 40391
Phone (859) 744-2623
330 Seven Springs Way
Brentwood, TN 37027
Phone (615) 920-7780
Interoperability endpoints
- stacey.anderson.1@19475.direct.athenahealth.com
- https://api.platform.athenahealth.com/19475/brand/10/csg/41/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 3009247 | KY | |
| Nurse Practitioner | 363L00000X | 3009247 | KY | Yes |
Addresses
Primary practice location
1225 S Broadway Ste 201
Lexington, KY 40504-2701
Mailing address
1221 S Broadway
Lexington, KY 40504-2701
Phone (859) 258-6200
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7100351200 | Medicaid | KY |
Other names
- Stacey Muir Wilson
Other providers in Lexington, KY
- Natalie M Anderson
- Natalie Michelle Anderson
- Rachel Haley Anderson
- Ryan Jeffery Anderson
- Shannon Anderson
- Susan Melina Anderson
- Tayler Anderson
- Kirsti Anderssen
- Reynold Andika
- Andilou LLC
All providers in Lexington, KY · Nurse Practitioner in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 2, 2024. 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.