Wayne Anthony Stackhouse

Primary specialty

NutritionistTaxonomy code 133N00000X

Practice address

3213 N 27TH St
Philadelphia, PA 19129-1808

Phone

(267) 742-4163

Fax

(267) 742-4163

NPI assigned

Jul 14, 2025

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1752451200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752451200000",
    "number": "1073404380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3213 N 27TH ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191291808",
            "telephone_number": "267-742-4163",
            "fax_number": "267-742-4163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3213 N 27TH ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191291808",
            "telephone_number": "267-742-4163",
            "fax_number": "267-742-4163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STACKHOUSE",
        "first_name": "WAYNE",
        "middle_name": "ANTHONY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-07-14",
        "last_updated": "2025-07-14",
        "certification_date": "2025-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133N00000X",
            "taxonomy_group": "",
            "desc": "Nutritionist",
            "state": "PA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Trevor Stacey, ATC
• Anthony Christopher Stack, DO
• Kathryn O'Sullivan Stack, MD
• Lori J Stack, MD
• Katherine Isabel Stackhouse, CRNP
• Caroline Stacks
• Anna Stacy, MD
• Arthur Petrie Staddon, MD
• Stadium Campus Ambulatory Surgical Center, LLC
• Edward A Stadtmauer, MD

• Nutritionist in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Nutritionist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 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.