Stephanie Katherine Dadds, FNP-BC

Key facts

NPI

1306329636

Entity type

Individual (NPI type 1)

Primary specialty

Family Nurse Practitioner 363LF0000X

License

R234084 (MD)

Practice address

2002 Medical Pkwy Ste 460
Annapolis, MD 21401-3263

Phone

(443) 481-4080

NPI assigned

Sep 12, 2018

Sex

Female

Sole proprietor

No

Organizations & group practices 3

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.

• Luminis Health Medical Group, LLC Maternal & Fetal Medicine Physician · Annapolis, MD · NPI 1073580205
  Medicare reassignment NPD MD
• Luminis Health Medical Group, LLC Internal Medicine Physician · Bowie, MD · NPI 1720835010
  NPD
• Luminis Health Medical Group, LLC Cognitive & Behavioral Psychologist · Annapolis, MD · NPI 1912306705
  NPD

Medicare participation

Medicare fee-for-service enrollment

Enrolled in MD

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Nurse Practitioner

Practice roles

Locations

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 16, 2019.

{
    "created_epoch": "1536710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1547596800000",
    "number": "1306329636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 MERRIMACK WAY",
            "city": "ARNOLD",
            "state": "MD",
            "postal_code": "210122579",
            "telephone_number": "410-903-6126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2002 MEDICAL PKWY STE 460",
            "city": "ANNAPOLIS",
            "state": "MD",
            "postal_code": "214013263",
            "telephone_number": "443-481-4080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DADDS",
        "first_name": "STEPHANIE",
        "middle_name": "KATHERINE",
        "name_prefix": "Mrs.",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-12",
        "last_updated": "2019-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MD",
            "license": "R234084",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MD",
            "license": "R234084",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "777729900",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "752086",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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All providers in Annapolis, MD · Family Nurse Practitioner in Maryland