Jack Allan Stauffer, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

629 Issued in SC

Practice address

435 N Cedar St
Summerville, SC 29483-6407

Phone

(843) 873-1592

Fax

(843) 820-3373

NPI assigned

May 3, 2006

Last updated

Aug 30, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Credentials

Nurse Practitioner

State licenses

Interoperability endpoints

• Direct secure messaging: jack.stauffer@ppcp1.eclinicaldirectplus.com

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

{
    "created_epoch": "1146614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472515200000",
    "number": "1396703740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 SIGMA DR",
            "address_2": "STE 100",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294867715",
            "telephone_number": "843-554-8312",
            "fax_number": "843-554-5141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "435 N CEDAR ST",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294836407",
            "telephone_number": "843-873-1592",
            "fax_number": "843-820-3373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STAUFFER",
        "first_name": "JACK",
        "middle_name": "ALLAN",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-03",
        "last_updated": "2016-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SC",
            "license": "629",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE PTAN",
            "identifier": "P00851396",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NP0021",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kelly Marie Starbuck, LPC
• Tyler John Starkweather, DPT
• Serena Stasko
• State of South Carolina (SC Dhec)
• Amanda Paige Stater, DDS
• Richard Anderson Steadman III, M.D.
• Avery Lauren Steeland
• Christopher Thomas Steeley, DMD
• Stephen
• Alonzo Steplight Jr.

• Family Nurse Practitioner in Summerville, SC
• Providers in Summerville, SC by specialty
• Family Nurse Practitioner in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2016; 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.