NPIMap

Individual provider Active NPI

Stacy Marie Blank, CNP

  • Nurse Practitioner
  • Mankato, MN
National Provider Identifier
1295213650
Registry record updated Oct 26, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
6040 Issued in MN
Practice address
1025 Marsh St
Mankato, MN 56001-4752
Phone
(507) 625-4031
NPI assigned
Jul 29, 2018
Last updated
Oct 26, 2020By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 26, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 6040 MN Primary

Addresses

Primary practice location

1025 Marsh St
Mankato, MN 56001-4752

Mailing address

PO Box 43
Minneapolis, MN 55440-0043
Phone (612) 262-1166

Other practice location 1

8675 Valley Creek Rd
Woodbury, MN 55125-2337
Phone (651) 241-3000

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address snovak91290@ehrdirect.mayoclinicmsg.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180911002881 MN Practitioner - Nurse Practitioner 8527318609 Reassigns benefits to 11 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mayo Clinic Health System-Southwest Minnesota RegionGroup PAC ID 4688585771, shared by 6 NPIs, 658 clinicians

Practice addresses (Care Compare)

101 Martin Luther King Dr
Jr
Mankato, MN 56001-6460
Phone (507) 385-6500

800 Medical Ctr Dr
Fairmont, MN 56031-4575
Phone (507) 238-8555

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
6040MNMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mayo Clinic Health System-St James CurrentSince Jun 9, 2022 Accepting new patients
Allina Health System CurrentSince Mar 16, 2020 Accepting new patients
Mayo Clinic Health System-Southeast Minnesota Region CurrentSince Mar 3, 2026 Accepting new patients
Mayo Clinic Health System-Southwest Minnesota Region Current Accepting new patients
Mayo Clinic Health System-Lake City CurrentSince Mar 3, 2026 Accepting new patients
Mayo Clinic Health System-Southeast Minnesota Region CurrentSince Mar 3, 2026 Accepting new patients
Allina Health System Current Accepting new patients
Mayo Clinic Health System-Fairmont CurrentSince Jun 9, 2022 Accepting new patients
Mayo Clinic Health System-Southwest Minnesota Region CurrentSince Sep 1, 2018 Accepting new patients
Mayo Clinic Health System-Southwest Minnesota Region CurrentSince Sep 1, 2018 Accepting new patients
Mayo Clinic Health System-Lake City CurrentSince Mar 3, 2026 Accepting new patients
Mayo Clinic Health System-Southwest Minnesota Region Current Accepting new patients
Mayo Clinic Health System-St James Current Accepting new patients
Mayo Clinic Health System-Southeast Minnesota Region CurrentSince Mar 3, 2026 Accepting new patients
Mayo Clinic Health System-Southwest Minnesota Region Current Accepting new patients
Allina Health System CurrentSince Mar 16, 2020 Accepting new patients

Locations

1000 1st Dr NW
Austin, MN 55912
Phone (507) 433-7351

32021 County 24 Blvd
Cannon Falls, MN 55009
Phone (507) 263-6000

800 Medical Center Dr
Fairmont, MN 56031
Phone (507) 238-8100

500 W Grant St
Lake City, MN 55041
Phone (651) 345-3321

101 Martin Luther King Dr
Mankato, MN 56001
Phone (507) 385-6500

1025 Marsh St
Mankato, MN 56001
Phone (507) 345-2623

2215 Park Ave
Minneapolis, MN 55404
Phone (612) 775-8800

2925 Chicago Ave
#10957
Minneapolis, MN 55407
Phone (612) 262-8640

301 2nd St NE
New Prague, MN 56071
Phone (952) 758-4431

200 1st St SW
Rochester, MN 55905
Phone (507) 266-4850

1101 Moulton and Parsons Dr
Saint James, MN 56081
Phone (507) 375-3261

501 State St N
Waseca, MN 56093
Phone (507) 781-8176

8675 Valley Creek Rd
Woodbury, MN 55125
Phone (651) 241-3000

Organizations & group practices 17

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

View all 17

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1532822400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603670400000",
    "number": "1295213650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 43",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554400043",
            "telephone_number": "612-262-1166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 MARSH ST",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560014752",
            "telephone_number": "507-625-4031"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8675 Valley Creek Rd",
            "address_purpose": "LOCATION",
            "city": "Woodbury",
            "state": "MN",
            "postal_code": "551252337",
            "country_code": "US",
            "telephone_number": "651-241-3000",
            "fax_number": "651-241-3500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLANK",
        "first_name": "STACY",
        "middle_name": "MARIE",
        "credential": "CNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-07-29",
        "last_updated": "2020-10-26",
        "certification_date": "2020-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MN",
            "license": "6040",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "snovak91290@ehrdirect.mayoclinicmsg.org",
            "affiliation": "N",
            "address_1": "1025 Marsh St",
            "city": "Mankato",
            "state": "MN",
            "country_code": "US",
            "postal_code": "560014752",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mankato, MN

Sources for this page

Verify at the official NPI Registry.