Individual provider Active NPI

Wayne Joe Stock, RN

  • Homemaker
  • Canon City, CO
National Provider Identifier
1417628504
Registry record updated Sep 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
HomemakerTaxonomy code 376J00000X
Practice address
1415 N 15TH St
Canon City, CO 81212-4624
Phone
(719) 276-1105
NPI assigned
Sep 28, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Homemaker 376J00000X Primary

Addresses

Primary practice location

1415 N 15TH St
Canon City, CO 81212-4624

Mailing address

815 Garden Park Rd
Canon City, CO 81212-8315
Phone (719) 276-1105

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
Credentials
Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Safe Watch, Inc. CurrentSince Nov 21, 2021 Accepting new patients
Safe Watch, Inc. CurrentSince Oct 5, 2021 Accepting new patients

Locations

1415 N 15th St
Canon City, CO 81212
Phone (719) 275-2034

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1632787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632787200000",
    "number": "1417628504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "815 GARDEN PARK RD",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "812128315",
            "telephone_number": "719-276-1105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 N 15TH ST",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "812124624",
            "telephone_number": "719-276-1105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STOCK",
        "first_name": "WAYNE",
        "middle_name": "JOE",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-09-28",
        "last_updated": "2021-09-28",
        "certification_date": "2021-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "376J00000X",
            "taxonomy_group": "",
            "desc": "Homemaker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canon City, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 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.

Verify at the official NPI Registry.