Stacy Anne Sullivan, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

8109 Issued in NC

Practice address

217 E Willow St
Yadkinville, NC 27055-8193

Phone

(336) 849-7777

NPI assigned

Feb 9, 2007

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

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1170979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1292284800000",
    "number": "1306987631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 457",
            "city": "YADKINVILLE",
            "state": "NC",
            "postal_code": "270550457",
            "telephone_number": "336-849-7777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "217 E WILLOW ST",
            "city": "YADKINVILLE",
            "state": "NC",
            "postal_code": "270558193",
            "telephone_number": "336-849-7777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "STACY",
        "middle_name": "ANNE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-09",
        "last_updated": "2010-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "8109",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5902245",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3404399",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Virginia Bennett Staley, M.A., CCC-SLP
• Statesville Hma Medical Group, LLC
• Denise Maria Steele, P.T.
• Lynn Helen Strole, MSW, LCSW
• Ashley Karinna Sugg, DPT
• Rebecca Gwyn Swan, REGISTERED NURSE
• The Center-a Strategic Interventions Facility
• The Mental Health Association in North Carolina, Inc
• The Mental Health Association in North Carolina, Inc
• Steven Thomasson, RPH

• General Practice Dentistry in Yadkinville, NC
• Providers in Yadkinville, NC by specialty
• General Practice Dentistry in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2010; 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.