NPIMap

Individual provider Active NPI

Katie Stucker, APRN

  • Nurse Practitioner
  • Ash Flat, AR
National Provider Identifier
1083065015
Registry record updated Jun 30, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
A004810 Issued in AR
Practice address
49 Highway 62 412
Ash Flat, AR 72513-9594
Phone
(870) 994-7301
Fax
(870) 994-7488
NPI assigned
Jun 30, 2016
Last updated
Jun 30, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X A004810 AR Primary

Addresses

Primary practice location

49 Highway 62 412
Ash Flat, AR 72513-9594

Mailing address

49 Highway 62 412
Ash Flat, AR 72513-9594
Phone (870) 994-7301

Other identifiers 1

IdentifierTypeStateIssuer
A004810OtherARARKANSAS NURSING BOARD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160722000658 AR Practitioner - Nurse Practitioner 0446543847 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bradley Bibb MD PLLCGroup PAC ID 4789715285, 71 clinicians

Practice addresses (Care Compare)

115 Turner LN
Salem, AR 72576-5600
Phone (870) 895-3238

3519 Hwy 63
Black Rock, AR 72415-9022
Phone (870) 878-4005

3809 E 9TH St
Suite 15
Texarkana, AR 71854-5818
Phone (870) 621-0080

4196 Hwy 62 412
Suite a
Hardy, AR 72542-8002
Phone (870) 994-7301

49 Hwy 62 412
Ash Flat, AR 72513-9594
Phone (870) 994-7301

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
A004810ARMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Bradley Bibb MD PLLC CurrentSince Jul 1, 2016 Accepting new patients
Bradley Bibb MD PLLC CurrentSince Jul 1, 2016 Accepting new patients
Bradley Bibb MD PLLC Current Accepting new patients
Ozarks Medical Center Past Accepting new patients
Bradley Bibb MD PLLC Past Accepting new patients

Locations

49 Highway 62 412
Ash Flat, AR 72513
Phone (573) 718-2570

49 Highway 62 412
Ste 412
Ash Flat, AR 72513

3519 Highway 63
Black Rock, AR 72415
Phone (870) 878-4005

10144 Highway 63 N
#A
Bono, AR 72416
Phone (870) 520-6069

3809 E 9th St
Ste 15
Texarkana, AR 71854
Phone (870) 621-0080

Interoperability endpoints

  • Direct secure messaging: katie.stucker.1@2424.direct.athenahealth.com

Organizations & group practices 5

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.

Hospital & facility affiliations 21

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1467244800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1467244800000",
    "number": "1083065015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "49 HIGHWAY 62 412",
            "city": "ASH FLAT",
            "state": "AR",
            "postal_code": "725139594",
            "telephone_number": "870-994-7301",
            "fax_number": "870-994-7488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "49 HIGHWAY 62 412",
            "city": "ASH FLAT",
            "state": "AR",
            "postal_code": "725139594",
            "telephone_number": "870-994-7301",
            "fax_number": "870-994-7488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STUCKER",
        "first_name": "KATIE",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-30",
        "last_updated": "2016-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AR",
            "license": "A004810",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARKANSAS NURSING BOARD",
            "identifier": "A004810",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ash Flat, AR

Sources for this page

Verify at the official NPI Registry.