Individual provider Active NPI

Stephanie Walters Wood

  • Neonatal Intensive Care Registered Nurse
  • Charlotte, NC
National Provider Identifier
1053940551
Registry record updated Nov 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal Intensive Care Registered NurseTaxonomy code 163WN0002X
License
279311 Issued in NC
Practice address
200 Hawthorne LN
Charlotte, NC 28204-2515
Phone
(704) 384-4000
NPI assigned
Apr 6, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 6, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Neonatal Intensive Care Registered Nurse 163WN0002X 279311 NC Primary
Pediatric Nurse Practitioner 363LP0200X 5015276 NC

Addresses

Primary practice location

200 Hawthorne LN
Charlotte, NC 28204-2515

Mailing address

200 Hawthorne LN
Charlotte, NC 28204-2515
Phone (704) 747-4713

Other practice location 1

200 Hawthorne Ln
Charlotte, NC 28204-2515
Phone (704) 747-4713

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

LicenseStateTypeSpecialty
279311NCMDNeonatal Intensive Care Registered Nurse
5015276NCMDPediatric Nurse Practitioner

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1586131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1762387200000",
    "number": "1053940551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 HAWTHORNE LN",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282042515",
            "telephone_number": "704-747-4713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 HAWTHORNE LN",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282042515",
            "telephone_number": "704-384-4000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 Hawthorne Ln",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282042515",
            "country_code": "US",
            "telephone_number": "704-747-4713",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WOOD",
        "first_name": "STEPHANIE",
        "middle_name": "WALTERS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-04-06",
        "last_updated": "2025-11-06",
        "certification_date": "2025-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WN0002X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Neonatal Intensive Care",
            "state": "NC",
            "license": "279311",
            "primary": true
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NC",
            "license": "5015276",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.