Active NPI
Carol Stack, APRN
- Psychiatric/Mental Health Clinical Nurse Specialist
- Brattleboro, VT
National Provider Identifier
1164526703
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric/Mental Health Clinical Nurse Specialist
- License
- 101-00112255
- Practice address
- Anna Marsh Lane
Brattleboro, VT 05302 - Phone
- (802) 257-7785
- NPI assigned
- Sep 12, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Clinical Nurse Specialist | 364SP0808X | 101-00112255 | VT | Primary |
Addresses
Primary practice location
Anna Marsh Lane
Brattleboro, VT 05302
Mailing address
Anna Marsh Lane
Brattleboro, VT 05302
Phone (802) 257-7785
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 101-0011225 | Other | VT | LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 101-00112255 | VT | MD | Psychiatric/Mental Health Clinical Nurse Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158019200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1220572800000",
"number": "1164526703",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "ANNA MARSH LANE",
"city": "BRATTLEBORO",
"state": "VT",
"postal_code": "05302",
"telephone_number": "802-257-7785"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "ANNA MARSH LANE",
"city": "BRATTLEBORO",
"state": "VT",
"postal_code": "05302",
"telephone_number": "802-257-7785"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STACK",
"first_name": "CAROL",
"credential": "APRN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-12",
"last_updated": "2008-09-05",
"status": "A"
},
"taxonomies": [
{
"code": "364SP0808X",
"taxonomy_group": "",
"desc": "Clinical Nurse Specialist, Psychiatric/Mental Health",
"state": "VT",
"license": "101-00112255",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "101-0011225",
"state": "VT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brattleboro, VT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.