Stephanie Diane Lilly, PMHNP-BC, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

APRN79287-FNP-BC Issued in WV

Practice address

1702 Conservation TRL Unit 104
Fort Walton Beach, FL 32547-5087

Phone

(304) 731-5195

Fax

(202) 951-6439

NPI assigned

Sep 26, 2018

Sex

Female

Sole proprietor

No

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

Enrolled in DC, FL2 enrollments

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 2

Specialty

Nurse Practitioner

Education

Other, 2018

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Group practices

PPCC, Inc.Group PAC ID 3870627284, 9 clinicians

Spring Leaf Solutions LLCGroup PAC ID 4981940178, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• PPCC, Inc.

  • Mental Health Counselor
  • Crestview, FL
  • NPI 1164747739
  Medicare reassignment Care Compare group NPD
• Spring Leaf Solutions, LLC

  • Community/Behavioral Health Agency
  • Washington, DC
  • NPI 1811495567
  Medicare reassignment Care Compare group NPD
• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  DC

  Medicare reassignment NPD
• Walden Lilly LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Fort Walton Beach, FL
  • NPI 1790547313
  NPD Authorized official
• Med Surg Physician Group, Inc.

  • Addiction (Substance Use Disorder) Counselor
  • Beckley, WV
  • NPI 1083373997
  NPD (past)

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

{
    "created_epoch": "1537920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709683200000",
    "number": "1194200147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1702 CONSERVATION TRL UNIT 104",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325475087",
            "telephone_number": "304-731-5195",
            "fax_number": "202-951-6439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1702 CONSERVATION TRL UNIT 104",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325475087",
            "telephone_number": "304-731-5195",
            "fax_number": "202-951-6439"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LILLY",
        "first_name": "STEPHANIE",
        "middle_name": "DIANE",
        "name_prefix": "Mrs.",
        "credential": "PMHNP-BC, FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-26",
        "last_updated": "2024-03-06",
        "certification_date": "2024-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WV",
            "license": "APRN79287-FNP-BC",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Marie Laura Liberty
• Lifeisbien Therapeutic Services
• Lifestyle Counseling
• Rachel Lightle
• Brianne Liles, ORT/L
• Jeffrey Lin, D.O.
• Lizmarie Linares, RBT
• Linda M Litschauer, LPN
• Little Hands Little Feet, LLC
• Living Free Therapy Services LLC

• Family Nurse Practitioner in Fort Walton Beach, FL
• Providers in Fort Walton Beach, FL by specialty
• Family Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.