Active NPI
Corey V Stacy, AT, ATC
- Athletic Trainer
- Canal Winchester, OH
National Provider Identifier
1376941377
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 004531
- Practice address
- 7397 Joshua Trce
Canal Winchester, OH 43110-7002 - Phone
- (740) 816-8420
- NPI assigned
- Dec 8, 2014
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 004531 | OH | Primary |
Addresses
Primary practice location
7397 Joshua Trce
Canal Winchester, OH 43110-7002
Mailing address
7397 Joshua Trce
Canal Winchester, OH 43110-7002
Phone (740) 816-8420
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
| License | State | Type | Specialty |
|---|---|---|---|
| 004531 | OH | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1417996800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1629763200000",
"number": "1376941377",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7397 JOSHUA TRCE",
"city": "CANAL WINCHESTER",
"state": "OH",
"postal_code": "431107002",
"telephone_number": "740-816-8420"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7397 JOSHUA TRCE",
"city": "CANAL WINCHESTER",
"state": "OH",
"postal_code": "431107002",
"telephone_number": "740-816-8420"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STACY",
"first_name": "COREY",
"middle_name": "V",
"credential": "AT, ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-12-08",
"last_updated": "2021-08-24",
"certification_date": "2021-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "OH",
"license": "004531",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Canal Winchester, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 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.