Stacey Nicole Gibson, CRNP
Individual provider Active NPI Family Nurse Practitioner · Hagerstown, MD
NPI 1154876423 · NPPES record last updated Aug 19, 2021
Key facts
- NPI
- 1154876423
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- R170910 (MD)
- Practice address
- 11110 Medical Campus Rd Ste 147
Hagerstown, MD 21742-6755 - Phone
- (301) 714-4350
- NPI assigned
- Aug 16, 2016
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Hospice of the Panhandle, Inc.
Practice addresses (Care Compare)
330 Hospice LN
Kearneysville, WV 25430-4547
Phone 30426404061241
Hospital & facility affiliations
- Panhandle Home Health, Inc.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WV
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20201021000740 | WV | Practitioner - Nurse Practitioner | 6507154945 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hospice of the Panhandle, Inc. | Current |
Accepting new patients | |
| Matrix Medical Plus | Current |
Accepting new patients | |
| Matrix Medical Network of West | Current |
Accepting new patients | |
| Hospice of the Panhandle, Inc. | Past |
Accepting new patients | |
| Frederick Health Hospital Inc | Past | Accepting new patients |
Locations
9201 E Mountain View Rd
Ste 220
Scottsdale, AZ 85258
Phone (480) 862-1883
209 Washington St W
Charleston, WV 25302
Phone 24852821166
330 Hospice Ln
Kearneysville, WV 25430
Phone (304) 264-0406
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | R170910 | MD | Yes |
Addresses
Primary practice location
11110 Medical Campus Rd Ste 147
Hagerstown, MD 21742-6755
Mailing address
11110 Medical Campus Rd Ste 147
Hagerstown, MD 21742-6755
Phone (301) 714-4350
Other practice location 1
11116 Medical Campus Rd
Hagerstown, MD 21742-6710
Phone (301) 988-7822
Other names
- Mrs. Stacey Nicole Talbert
Other providers in Hagerstown, MD
- Suhair Ghanim
- Hridaya Bibhu Ghimire
- Lauren Gibble
- Charles Larry Gibbs Jr.
- Joseph Gibney
- Victoria Marie Saah Giffi
- William David Gift
- Jonathan Craig Gilbart
- Gilbert Weaver and Associates
- Teresa S Gilbert
All providers in Hagerstown, MD · Family Nurse Practitioner in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 19, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.