Savannah Lavinia Stackhouse

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

5020623 Issued in NC

Practice address

2125 Valleygate Dr Ste 102
Fayetteville, NC 28304-3753

Phone

(910) 864-0689

NPI assigned

Aug 12, 2024

Sex

Female

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

Enrolled in NC

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

State licenses

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

{
    "created_epoch": "1723420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723420800000",
    "number": "1093546145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2125 VALLEYGATE DR STE 102",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043753",
            "telephone_number": "910-864-0689"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2125 VALLEYGATE DR STE 102",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043753",
            "telephone_number": "910-864-0689"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STACKHOUSE",
        "first_name": "SAVANNAH",
        "middle_name": "LAVINIA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-08-12",
        "last_updated": "2024-08-12",
        "certification_date": "2024-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5020623",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• SRRC Psychology
• St Marys HCA of South Carolina
• St Marys Home Care Agency
• Ricci St. Jules, M.S., D.O
• Annie Stackhouse
• Tymera Dreyona Idasia Stafford
• Felicia Stakely
• Melissa M Stamates, M.D.
• Noah Dustin Stamp
• Standing in the Gap of North Carolina, LLC

• Family Nurse Practitioner in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Family Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2024; 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.