Coretta Stallworth, FNP -C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

COA-15366-NP Issued in OH

Practice address

3333 Burnet Avenue
MLC 6015
Cincinnati, OH 45229-3026

Phone

(513) 636-0800

Fax

(513) 803-0823

NPI assigned

Nov 27, 2013

Last updated

Nov 17, 2021By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in OH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Children's Hospital Medical Center

  dba Cincinnati Children's Hospital Medical Center

  • Pediatrics Physician
  • Cincinnati, OH
  • NPI 1609915784

  Nurse Practitioner

  Medicare reassignment NPD
• The Little Clinic of Ohio LLC

  • Family Nurse Practitioner
  • Cincinnati, OH
  • NPI 1982761896
  Medicare reassignment NPD
• University Surgical-Dental Associates, LLC

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Cincinnati, OH
  • NPI 1649241787
  NPD (past)

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

{
    "created_epoch": "1385510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637107200000",
    "number": "1073943106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3333 BURNET AVENUE",
            "address_2": "MLC 6015",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452293026",
            "telephone_number": "513-636-0800",
            "fax_number": "513-803-0823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 BURNET AVENUE",
            "address_2": "MLC 6015",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452293026",
            "telephone_number": "513-636-0800",
            "fax_number": "513-803-0823"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "234 Goodman St",
            "address_2": "3 South, Credentialing",
            "address_purpose": "LOCATION",
            "city": "Cincinnati",
            "state": "OH",
            "postal_code": "452192364",
            "country_code": "US",
            "telephone_number": "513-584-8577",
            "fax_number": "513-584-5618",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "234 Goodman St",
            "address_2": "3 South, Credentialing",
            "address_purpose": "LOCATION",
            "city": "Cincinnati",
            "state": "OH",
            "postal_code": "452192364",
            "country_code": "US",
            "telephone_number": "513-584-8577",
            "fax_number": "513-584-5618",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "560 Wessel Dr",
            "address_purpose": "LOCATION",
            "city": "Fairfield",
            "state": "OH",
            "postal_code": "450143776",
            "country_code": "US",
            "telephone_number": "513-454-2084",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STALLWORTH",
        "first_name": "CORETTA",
        "name_prefix": "Mrs.",
        "credential": "FNP -C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-11-27",
        "last_updated": "2021-11-17",
        "certification_date": "2021-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "OH",
            "license": "APRN.CNP.15366",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OH",
            "license": "COA-15366-NP",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OH",
            "license": "COA 15366 NP",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1073943106",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0098923",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Dennis Lee Stallo
• Johnna Stallo
• Jason M Stallons, PT
• Brandie Miya Stallworth
• Candace Stallworth
• Jerrhonda Anne Stallworth
• Milashey Lafayette Stallworth
• Nyrie Stallworth
• Rion Stallworth, RN
• Samantha Latosha Stallworth

• Family Nurse Practitioner in Cincinnati, OH
• Providers in Cincinnati, OH by specialty
• Family Nurse Practitioner in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.