Stacey Lynn Childress, AGPCNP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

23153 Issued in SC

Practice address

316 Calhoun St
Charleston, SC 29401-1113

Phone

(843) 724-2450

NPI assigned

Oct 20, 2014

Last updated

May 31, 2022By 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 1

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

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

Specialty

Nurse Practitioner

Education

Other, 2014

Medicare assignment

May accept Medicare assignment

Group practices

Pruitthealth Hospice IncGroup PAC ID 2264344217, 42 clinicians

Columbia Nephrology Associates PAGroup PAC ID 9537128533, 33 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

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.

• Pruitthealth Hospice, Inc.

  dba PruittHealth Hospice - Anderson

  • Community Based Hospice Care Agency
  • Anderson, SC
  • NPI 1174878342
  Medicare reassignment Care Compare group NPD
• Columbia Nephrology Associates PA

  • Specialist
  • Columbia, SC
  • NPI 1407821721
  Medicare reassignment Care Compare group
• Roper Hospital, Inc.

  dba The Ryan White Wellness Center

  • Infectious Disease Physician
  • Charleston, SC
  • NPI 1104150739
  Medicare reassignment NPD
• Roper Saint Francis Physicians Network

  dba Roper St. Francis Physician Partners General Surgery

  • Surgery Physician
  • Charleston, SC
  • NPI 1124431606
  Medicare reassignment NPD
• Roper Hospital Inc.

  dba Vascular Medicine and Wound Management Clinic

  • Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
  • N Charleston, SC
  • NPI 1104563758
  NPD
• Roper Hospital, Inc.

  dba Center for Spinal Cord Injury

  • Physical Medicine & Rehabilitation Physician
  • Charleston, SC
  • NPI 1992090229
  NPD
• Roper Saint Francis Physicians Network

  dba Roper St. Francis Post Acute Care

  • Internal Medicine Physician
  • Charleston, SC
  • NPI 1659926574
  NPD
• Roper Saint Francis Physicians Network

  dba Roper St. Francis Physician Partners Charleston OB/GYN

  • Obstetrics & Gynecology Physician
  • Charleston, SC
  • NPI 1811857352
  NPD
• Pruitthealth Hospice, Inc.

  dba PruittHealth Hospice - Eastern Carolina

  • Community Based Hospice Care Agency
  • Greenville, NC
  • NPI 1992744361
  NPD

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

{
    "created_epoch": "1413763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653955200000",
    "number": "1083018030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751649",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282751649",
            "telephone_number": "843-789-1620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "316 CALHOUN ST",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294011113",
            "telephone_number": "843-724-2450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHILDRESS",
        "first_name": "STACEY",
        "middle_name": "LYNN",
        "credential": "AGPCNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-10-20",
        "last_updated": "2022-05-31",
        "certification_date": "2022-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "SC",
            "license": "23153",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Katherine Elizabeth Chike Harris, DNP, CPNP, NE
• Children's Therapy Services, Inc.
• Heather Meredith Childress, CRNA
• Kathryn L Childress, PAAA
• Shawn Childress
• Katherine Turner Childrey, OTD, OTR/L
• Leah Rochelle Chiles, M.D.
• Caitlyn Chimento, BSN, RN
• Marc Ivor Chimowitz, M.D.
• Steve H Chin, MD

• Adult Health Nurse Practitioner in Charleston, SC
• Providers in Charleston, SC by specialty
• Adult Health Nurse Practitioner in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.