Individual provider Active NPI

Kirsten Stacy

  • Occupational Therapist
  • Johnson City, TN
National Provider Identifier
1306450036
Registry record updated Sep 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
6680 Issued in TN
Practice address
2214 E Fairview Ave
Johnson City, TN 37601-2860
Phone
(423) 928-6464
Fax
(423) 232-7970
NPI assigned
Sep 1, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 6680 TN Primary

Addresses

Primary practice location

2214 E Fairview Ave
Johnson City, TN 37601-2860

Mailing address

PO Box 191
Johnson City, TN 37605-0191
Phone (423) 928-6464

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

State licenses

LicenseStateTypeSpecialty
6680TNMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Therapy Occupational Therapist CurrentSince Mar 16, 2021 Accepting new patients
Mini Miracles Pediatric Therapy, PLLC CurrentSince Sep 6, 2020 Accepting new patients

Locations

109 Meadow View Rd
Ste 6
Bristol, TN 37620

2214 E Fairview Ave
Johnson City, TN 37601
Phone (423) 928-6464

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1598918400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598918400000",
    "number": "1306450036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 191",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376050191",
            "telephone_number": "423-928-6464",
            "fax_number": "423-232-7970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2214 E FAIRVIEW AVE",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376012860",
            "telephone_number": "423-928-6464",
            "fax_number": "423-232-7970"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STACY",
        "first_name": "KIRSTEN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-01",
        "last_updated": "2020-09-01",
        "certification_date": "2020-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "TN",
            "license": "6680",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnson City, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.