Active NPI
Stacie Rennie Avery, PA-C
- Physician Assistant
- Columbia, MO
National Provider Identifier
1023079407
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- AMD 272
- Practice address
- 800 Hospital Dr
Columbia, MO 65201-5275 - Phone
- (573) 814-6000
- NPI assigned
- Mar 28, 2006
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | AMD 272 | HI | Primary |
Addresses
Primary practice location
800 Hospital Dr
Columbia, MO 65201-5275
Mailing address
800 Hospital Dr
Columbia, MO 65201-5275
Phone (573) 814-6000
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)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AMD 272 | HI | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143504000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1697587200000",
"number": "1023079407",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "800 HOSPITAL DR",
"city": "COLUMBIA",
"state": "MO",
"postal_code": "652015275",
"telephone_number": "573-814-6000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 HOSPITAL DR",
"city": "COLUMBIA",
"state": "MO",
"postal_code": "652015275",
"telephone_number": "573-814-6000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AVERY",
"first_name": "STACIE",
"middle_name": "RENNIE",
"name_prefix": "Ms.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-28",
"last_updated": "2023-10-18",
"certification_date": "2023-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "HI",
"license": "AMD 272",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbia, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.