Individual provider Active NPI

Staci Sithembile Harris, NP

  • Nurse Practitioner
  • Charlotte, NC
National Provider Identifier
1134679012
Registry record updated Oct 31, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
5009104 Issued in NC
Practice address
108 Providence Rd
Charlotte, NC 28207-1218
Phone
(704) 287-8604
NPI assigned
Oct 4, 2016
Last updated
Oct 31, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 5009104 NC Primary
Adult Health Nurse Practitioner 363LA2200X 5009104 NC
Primary Care Nurse Practitioner 363LP2300X 20490 SC

Addresses

Primary practice location

108 Providence Rd
Charlotte, NC 28207-1218

Mailing address

PO Box 60447
Charlotte, NC 28260-0447

Other practice location 1

2550 S 41st St
Wilmington, NC 28403-5519
Phone (704) 695-1421

Other identifiers 1

IdentifierTypeStateIssuer
0000000MedicaidNC

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20170713001236 NC Practitioner - Nurse Practitioner 8325317993 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Novant Health Medical Group, LLCGroup PAC ID 1153234893, 2,413 clinicians
Liberty Healthcare Group LLCGroup PAC ID 4587574355, 9 clinicians

Practice addresses (Care Compare)

10810 Mallard Creek Rd
Charlotte, NC 28262-9786
Phone (704) 510-8000

119 W Wade St
Wadesboro, NC 28170-2136
Phone (704) 694-5992

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5009104NCMDAdult Health Nurse Practitioner
20490SCMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Novant Health Medical Group, LLC CurrentSince Oct 3, 2025 Accepting new patients
Novant Health Medical Group, LLC Current Accepting new patients
Novant Health Medical Group, LLC CurrentSince Oct 3, 2025 Accepting new patients
Liberty Healthcare Group, LLC CurrentSince Apr 3, 2017 Accepting new patients
Liberty Healthcare Group LLC CurrentSince Apr 3, 2017 Accepting new patients
Novant Health Medical Group, LLC Past Accepting new patients

Locations

10011 Providence Rd W
Charlotte, NC 28277
Phone (980) 245-8500

108 Providence Rd
Charlotte, NC 28207
Phone (336) 277-3431

10810 Mallard Creek Rd
Charlotte, NC 28262
Phone (704) 510-8000

2700 Royal Commons Ln
Matthews, NC 28105
Phone (704) 636-7181

5145 Sellers Rd
Shallotte, NC 28470
Phone (910) 754-4441

119 W Wade St
Wadesboro, NC 28170
Phone (704) 694-5992

1402 Pinckney St
Whiteville, NC 28472
Phone (910) 642-4245

44 McNeill Plz
Whiteville, NC 28472
Phone (910) 642-0224

2334 41st St
Wilmington, NC 28403
Phone (910) 815-3122

2550 41st St
Wilmington, NC 28403
Phone (910) 251-8111

420 Eastwood Rd
Ste 102
Wilmington, NC 28403
Phone (910) 251-8111

2825 Lyndhurst Ave
Ste 101
Winston Salem, NC 27103
Phone (336) 277-6300

Interoperability endpoints

  • Direct secure messaging: sharris243448@direct.novanthealth.org

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1475539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761868800000",
    "number": "1134679012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 PROVIDENCE RD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282071218",
            "telephone_number": "704-287-8604"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2550 S 41st St",
            "address_purpose": "LOCATION",
            "city": "Wilmington",
            "state": "NC",
            "postal_code": "284035519",
            "country_code": "US",
            "telephone_number": "704-695-1421",
            "fax_number": "704-694-7748",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "STACI",
        "middle_name": "SITHEMBILE",
        "name_prefix": "Mrs.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-10-04",
        "last_updated": "2025-10-31",
        "certification_date": "2025-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5009104",
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NC",
            "license": "5009104",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "SC",
            "license": "20490",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0000000",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.