Stacey Diane Stark, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

2025038960 Issued in MO

Practice address

2340 Katy LN
Poplar Bluff, MO 63901-2300

Phone

(573) 290-3293

NPI assigned

Aug 25, 2025

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 MO

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, 2025

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Womens Health Specialists PCGroup PAC ID 6406834951, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• Womens Health Specialists, PC

  • Obstetrics & Gynecology Physician
  • Poplar Bluff, MO
  • NPI 1184686925
  Medicare reassignment Care Compare group NPD
• Womens Health Specialists, PC

  • Rural Health Clinic/Center
  • Poplar Bluff, MO
  • NPI 1467047738
  NPD

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

{
    "created_epoch": "1756080000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757894400000",
    "number": "1104704477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 MERLIN DR",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639018374",
            "telephone_number": "573-718-9831"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2340 KATY LN",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639012300",
            "telephone_number": "573-290-3293"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STARK",
        "first_name": "STACEY",
        "middle_name": "DIANE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-08-25",
        "last_updated": "2025-09-15",
        "certification_date": "2025-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2025038960",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• St. Louis JC Vamc
• Steven Stacy, MRC, LPC
• Derek Anthony Stamps, BS
• Tanner Elizabeth Stanfield
• Candice Dawn Stansfield, APRN-BC, FNP
• State of Missouri
• State of Missouri
• State of Missouri
• State of Missouri
• State of Missouri

• Family Nurse Practitioner in Poplar Bluff, MO
• Providers in Poplar Bluff, MO by specialty
• Family Nurse Practitioner in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2025; 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.