Staci Lynn Ervin, APRN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

A110802 Issued in IA

Practice address

1021 Nebraska St
Sioux City, IA 51105-1436

Phone

(712) 252-2477

Fax

(712) 252-5920

NPI assigned

Dec 13, 2012

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in NE, IA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: servin637031@direct.ochin.org
• Direct secure messaging: staci.ervin@423525067128836.direct.elationemr.com

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.

• Siouxland Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Sioux City, IA
  • NPI 1558355305
  Medicare reassignment NPD
• Siouxland Community Health Center

  • Federally Qualified Health Center (FQHC)
  • South Sioux City, NE
  • NPI 1912378480
  Medicare reassignment NPD

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

{
    "created_epoch": "1355356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623628800000",
    "number": "1346586757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1021 NEBRASKA ST",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511051436",
            "telephone_number": "712-252-2477",
            "fax_number": "712-252-5920"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1021 NEBRASKA ST",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511051436",
            "telephone_number": "712-252-2477",
            "fax_number": "712-252-5920"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3410 Futures Dr",
            "address_purpose": "LOCATION",
            "city": "South Sioux City",
            "state": "NE",
            "postal_code": "687763917",
            "country_code": "US",
            "telephone_number": "402-412-7242",
            "fax_number": "712-252-5920",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ERVIN",
        "first_name": "STACI",
        "middle_name": "LYNN",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-12-13",
        "last_updated": "2021-06-14",
        "certification_date": "2021-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NE",
            "license": "111449",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IA",
            "license": "A110802",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "111449",
            "state": "NE"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "A110802",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kylie Michelle Eriksen, CRNA
• Patti Eriksen, RN
• Jerold Clancy Erlandson, MD
• Khatu Vivienne Erlbacher, PHARM.D.
• Timothy Joseph Ernesti, DDS
• Michael J Esch, LISW
• Kara Lee Estabrook, PHARMD
• Eloisa Estrada, CADC
• Evan Ruterbories DC PC
• Katherine Ann Evans, DO

• Family Nurse Practitioner in Sioux City, IA
• Providers in Sioux City, IA by specialty
• Family Nurse Practitioner in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.