Stacye Dick, GNP-BC

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

256896 Issued in TX

Practice address

14121 Parke Long CT
Suite 200 & 201
Chantilly, VA 20151-1647

Phone

(571) 449-3585

Fax

(800) 752-2471

NPI assigned

Oct 4, 2013

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1380844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1380844800000",
    "number": "1124455118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14121 PARKE LONG CT",
            "address_2": "SUITE 200 & 201",
            "city": "CHANTILLY",
            "state": "VA",
            "postal_code": "201511647",
            "telephone_number": "571-449-3585",
            "fax_number": "800-752-2471"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14121 PARKE LONG CT",
            "address_2": "SUITE 200 & 201",
            "city": "CHANTILLY",
            "state": "VA",
            "postal_code": "201511647",
            "telephone_number": "571-449-3585",
            "fax_number": "800-752-2471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DICK",
        "first_name": "STACYE",
        "credential": "GNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-10-04",
        "last_updated": "2013-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "TX",
            "license": "256896",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Gerontology Nurse Practitioner in Chantilly, VA
• Providers in Chantilly, VA by specialty
• Gerontology Nurse Practitioner in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.