NPIMap

Individual provider Active NPI

Kendra K Stacey, ARNP

  • Family Nurse Practitioner
  • Lawton, OK
National Provider Identifier
1124014790
Registry record updated Feb 12, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R0052337 Issued in OK
Practice address
102 NW 31St
Lawton, OK 73505
Phone
(580) 353-6790
Fax
(580) 510-7019
NPI assigned
Sep 20, 2005
Last updated
Feb 12, 2008By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2008

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R0052337 OK Primary
Obstetrics & Gynecology Nurse Practitioner 363LX0001X R0052337 OK

Addresses

Primary practice location

102 NW 31St
Lawton, OK 73505

Mailing address

PO Box 785
Lawton, OK 73502
Phone (580) 357-9984

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
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
I20100215000570 OK Practitioner - Nurse Practitioner 7517001555 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

823 D St
Snyder, OK 73566-2031
Phone (580) 569-2373

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R0052337OKMDObstetrics & Gynecology Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Comanche County Healthcare Corporation CurrentSince Mar 1, 1996 Accepting new patients
Comanche County Healthcare Corporation Current Accepting new patients
Comanche County Healthcare CurrentSince Mar 1, 1996 Accepting new patients
Jackson County Memorial Hospital Authority Past Accepting new patients
Comanche County Healthcare Past Accepting new patients
Summit Medical Center Past Accepting new patients
Comanche County Hospital Authority Past Accepting new patients

Locations

319 E Josephine Ave
Frederick, OK 73542
Phone (580) 335-7545

102 NW 31st St
Lawton, OK 73505
Phone (580) 353-6790

3201 W Gore Blvd
Ste 201
Lawton, OK 73505
Phone (580) 357-2261

3201 W Gore Blvd
Ste 300
Lawton, OK 73505
Phone (580) 248-5255

823 D St
Snyder, OK 73566
Phone (580) 569-2373

Interoperability endpoints

  • Direct secure messaging: kendra.stacey@mmg.eclinicaldirectplus.com

Organizations & group practices 7

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 7

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

NPI Registry JSON

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

{
    "created_epoch": "1127174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1202774400000",
    "number": "1124014790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 785",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "73502",
            "telephone_number": "580-357-9984",
            "fax_number": "580-357-3277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 NW 31ST",
            "city": "LAWTON",
            "state": "OK",
            "postal_code": "73505",
            "telephone_number": "580-353-6790",
            "fax_number": "580-510-7019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STACEY",
        "first_name": "KENDRA",
        "middle_name": "K",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-20",
        "last_updated": "2008-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "OK",
            "license": "R0052337",
            "primary": true
        },
        {
            "code": "363LX0001X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Obstetrics & Gynecology",
            "state": "OK",
            "license": "R0052337",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawton, OK

Sources for this page

Verify at the official NPI Registry.