Active NPI
Tracy M Stallworth
- Contractor
- Kissimmee, FL
National Provider Identifier
1356926166
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- Practice address
- 4302 Heliotrope Loop
Kissimmee, FL 34746-3477 - Phone
- (407) 883-1243
- NPI assigned
- Mar 12, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | Primary |
Addresses
Primary practice location
4302 Heliotrope Loop
Kissimmee, FL 34746-3477
Mailing address
4302 Heliotrope Loop
Kissimmee, FL 34746-3477
Phone (407) 883-1243
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1615507200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1615507200000",
"number": "1356926166",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4302 HELIOTROPE LOOP",
"city": "KISSIMMEE",
"state": "FL",
"postal_code": "347463477",
"telephone_number": "407-883-1243"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4302 HELIOTROPE LOOP",
"city": "KISSIMMEE",
"state": "FL",
"postal_code": "347463477",
"telephone_number": "407-883-1243"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STALLWORTH",
"first_name": "TRACY",
"middle_name": "M",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-03-12",
"last_updated": "2021-03-12",
"certification_date": "2021-03-12",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kissimmee, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.