Active NPI
Stacy Marie Fairley, ACNP
- Acute Care Nurse Practitioner
- San Jose, CA
National Provider Identifier
1255673703
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acute Care Nurse Practitioner
- License
- 21687
- Practice address
- 250 Hospital Pkwy
San Jose, CA 95119-1103 - Phone
- (408) 972-7000
- NPI assigned
- Mar 22, 2013
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Acute Care Nurse Practitioner | 363LA2100X | 21687 | CA | Primary |
Addresses
Primary practice location
250 Hospital Pkwy
San Jose, CA 95119-1103
Mailing address
250 Hospital Pkwy
San Jose, CA 95119-1103
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)
- Not enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21687 | CA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1363910400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1363910400000",
"number": "1255673703",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "250 HOSPITAL PKWY",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951191103"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "250 HOSPITAL PKWY",
"city": "SAN JOSE",
"state": "CA",
"postal_code": "951191103",
"telephone_number": "408-972-7000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAIRLEY",
"first_name": "STACY",
"middle_name": "MARIE",
"name_prefix": "Mrs.",
"credential": "ACNP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2013-03-22",
"last_updated": "2013-03-22",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2100X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Acute Care",
"state": "CA",
"license": "21687",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Jose, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.