Jacqueline Michelle Stacy, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA 2347 Issued in AR

Practice address

110 W 13TH St
Murfreesboro, AR 71958-9501

Phone

(870) 285-2168

NPI assigned

Oct 23, 2009

Last updated

Oct 24, 2009By 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1256256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1256342400000",
    "number": "1144556259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "140 RAILROAD ST",
            "address_2": "P.O. BOX 564",
            "city": "TYRONZA",
            "state": "AR",
            "postal_code": "723869416",
            "telephone_number": "870-514-9722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 W 13TH ST",
            "city": "MURFREESBORO",
            "state": "AR",
            "postal_code": "719589501",
            "telephone_number": "870-285-2168"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STACY",
        "first_name": "JACQUELINE",
        "middle_name": "MICHELLE",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-10-23",
        "last_updated": "2009-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "AR",
            "license": "PTA 2347",
            "primary": true
        },
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "NC",
            "license": "4268",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Southwest Arkansas Healthcare (Pike County Hospital Family Clinic Of Dierks)
• Southwest Arkansas Healthcare (Generations Of Hope Geriatric Psychiatry Unit)
• Southwest Arkansas Healthcare LLC (Pike County Hosptial Home Health)
• Southwest Arkansas Healthcare, LLC (Tri-Lakes Medical Center ER)
• Southwest Arkansas Healthcare, LLC (Pike County Hospital)
• State of Arkansas (Pike County Health Unit)
• Amelia Sweeden
• Regina Tatum
• Darwin Turner, DDS
• Urgent Care of Pike County LLC

• Physical Therapy Assistant in Murfreesboro, AR
• Providers in Murfreesboro, AR by specialty
• Physical Therapy Assistant in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2009; 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.