Annie Stackhouse

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

206304 Issued in NC

Practice address

2920 Eastover North Dr
Fayetteville, NC 28312-6707

Phone

(910) 261-3633

NPI assigned

Jun 4, 2024

Last updated

Jul 25, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Keyahs Care

  • Emotionally Disturbed Childrens' Residential Treatment Facility
  • Fayetteville, NC
  • NPI 1942048046
  NPD Authorized official

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

{
    "created_epoch": "1717459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721865600000",
    "number": "1306687298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2920 EASTOVER NORTH DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283126707",
            "telephone_number": "910-261-3633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2920 EASTOVER NORTH DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283126707",
            "telephone_number": "910-261-3633"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "517 Mayview St",
            "address_purpose": "LOCATION",
            "city": "Fayetteville",
            "state": "NC",
            "postal_code": "283061749",
            "country_code": "US",
            "telephone_number": "910-261-3633",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STACKHOUSE",
        "first_name": "ANNIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-06-04",
        "last_updated": "2024-07-25",
        "certification_date": "2024-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NC",
            "license": "206304",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heather Marie Sroka, BSW, MSW, LCSW-A
• SRRC Psychology
• St Marys HCA of South Carolina
• St Marys Home Care Agency
• Ricci St. Jules, M.S., D.O
• Savannah Lavinia Stackhouse
• Tymera Dreyona Idasia Stafford
• Felicia Stakely
• Melissa M Stamates, M.D.
• Noah Dustin Stamp

• Registered Nurse in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Registered Nurse in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2024; 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.