Jessica Leigh Stacy, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95002256 Issued in CA

Practice address

9500 Gilman Dr
La Jolla, CA 92093-1921

Phone

(858) 534-3300

NPI assigned

Jan 19, 2011

Last updated

Apr 13, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Physician Groups LC

  • Multi-Specialty Clinic/Center
  • Saint Louis, MO
  • NPI 1285664268
  NPD (past)

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

{
    "created_epoch": "1295395200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681344000000",
    "number": "1407151780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "725 DEWEY AVE",
            "city": "FARMINGTON",
            "state": "MO",
            "postal_code": "636402935",
            "telephone_number": "573-631-3192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9500 GILMAN DR",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920931921",
            "telephone_number": "858-534-3300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "300 Health Way Dr",
            "address_purpose": "LOCATION",
            "city": "Potosi",
            "state": "MO",
            "postal_code": "636641420",
            "country_code": "US",
            "telephone_number": "573-436-5451",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STACY",
        "first_name": "JESSICA",
        "middle_name": "LEIGH",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-01-19",
        "last_updated": "2023-04-13",
        "certification_date": "2023-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2019028114",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "CA",
            "license": "95002256",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2010042113",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95002256",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephen Daniel Sprinkle, PH.D.
• Paige Read Squiller, PA
• Mary Fox Squire, PH.D.
• Mathieu Squires
• Shanmukha Srinivas
• Michael Treavelyn Stafford, D.C.
• Matthew Carlton Stagg
• Richard Duane Stahl, MD
• Gregory Allen Stainer, MD FACS
• Barbara Eloise Stangl, MSN FNP-BC

• Family Nurse Practitioner in La Jolla, CA
• Providers in La Jolla, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2023; 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.