Stacie Anderson, AGNP

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

95029378 Issued in CA

Practice address

19270 Sonoma Highway
Sonoma, CA 95476

Phone

(707) 939-6070

NPI assigned

May 22, 2024

Last updated

May 22, 2024By 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 3

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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 1

Specialty

Nurse Practitioner

Education

Other, 2023

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Hospital & facility affiliations

• Sonoma Valley Hospital Hospital, Sonoma, CA, CCN 050090

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Sonoma Valley Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Sonoma, CA
  • NPI 1770669715
  Medicare reassignment
• Sonoma Valley Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Sonoma, CA
  • NPI 1427118942
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Sonoma Valley Health Care District

  dba Sonoma Valley Hospital

  • General Acute Care Hospital
  • Sonoma, CA
  • NPI 1710063870
  Care Compare affiliation

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

{
    "created_epoch": "1716336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716336000000",
    "number": "1407695182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "911 LAKEVILLE ST # 116",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949523329",
            "telephone_number": "509-999-3989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19270 SONOMA HIGHWAY",
            "city": "SONOMA",
            "state": "CA",
            "postal_code": "95476",
            "telephone_number": "707-939-6070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "STACIE",
        "credential": "AGNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-05-22",
        "last_updated": "2024-05-22",
        "certification_date": "2024-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "95029378",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "CA",
            "license": "95029378",
            "primary": true
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "CA",
            "license": "95029378",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dominic Paul Amara, M.D.
• Lee Noel Amari, PHARM D
• Amedisys California LLC (Amedisys Home Health)
• Reuben Makala Anders, MD
• Douglas Anderson, PHD
• Arc Therapy Services, LLC (Brookdale Home Health)
• Robert Arguelles
• Rebekka Anne Armstrong, PTA
• Carrie Atkinson, LAADC, LMFT
• Audrey Kang DDS Dental Corporation

• Gerontology Nurse Practitioner in Sonoma, CA
• Providers in Sonoma, CA by specialty
• Gerontology Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.