Stacey M Carroll, PHD, APRN-BC

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

212620 Issued in MA

Practice address

18 Wayland Cir
Holden, MA 01520-2439

Phone

(508) 829-7847

NPI assigned

Jan 7, 2008

Last updated

Feb 10, 2008By 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 2

Addresses

Other names 1

• Ms. Stacey M Cordwell Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner, Doctor of Philosophy

State licenses

Practice roles

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.

• Servicenet Inc

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Northampton, MA
  • NPI 1659314425
  NPD (past)

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

{
    "created_epoch": "1199664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1202601600000",
    "number": "1114102332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18 WAYLAND CIR",
            "city": "HOLDEN",
            "state": "MA",
            "postal_code": "015202439",
            "telephone_number": "508-829-7847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18 WAYLAND CIR",
            "city": "HOLDEN",
            "state": "MA",
            "postal_code": "015202439",
            "telephone_number": "508-829-7847"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARROLL",
        "first_name": "STACEY",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "PHD,  APRN-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-01-07",
        "last_updated": "2008-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MA",
            "license": "212620",
            "primary": true
        },
        {
            "code": "163WG0600X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Gerontology",
            "state": "MA",
            "license": "212620",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACEY",
            "last_name": "CORDWELL",
            "middle_name": "M",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• C. Graham Campbell, PH.D.
• Neil F Cannon, M.D.
• Sarah Cardullo, PSY.D.
• Care Elite Nursing Agency
• Jennifer Carlson, PH.D., LCSW, CEM
• Taylor Caruso-Fahey
• Daniel Cassel
• Frenk Caushi
• Central Mass Counseling and Wellness
• Daniel Chapelle, PH.D.

• Adult Health Nurse Practitioner in Holden, MA
• Providers in Holden, MA by specialty
• Adult Health Nurse Practitioner in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2008; 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.