Spectrum the Other Clinic

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

Legal business name

SPECTRUM THE OTHER CLINIC

Practice address

709 Hardy St
Hattiesburg, MS 39401-3666

Phone

(601) 466-9495

Fax

(601) 469-9965

NPI assigned

Oct 17, 2019

Organization subpart

No

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

Authorized official

Name

Stacie M Pace, CNPNPI 1528480035

Title

Owner/Director

Phone

(601) 466-9495

Specialties & licenses 5

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Stacie Pace, AGACNP, AGPCNP

  • Nurse Practitioner
  • Hattiesburg, MS
  • NPI 1528480035
  NPD Authorized official
• Lee Pace, FNP, OTR

  • Family Nurse Practitioner
  • Hattiesburg, MS
  • NPI 1073811717
  NPD

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

{
    "created_epoch": "1571270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1617667200000",
    "number": "1447893888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2910 MAGNOLIA PL",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394022428",
            "telephone_number": "601-466-9495",
            "fax_number": "601-469-9965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "709 HARDY ST",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394013666",
            "telephone_number": "601-466-9495",
            "fax_number": "601-469-9965"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1846 E Innovation Park Dr Ste 100",
            "address_purpose": "LOCATION",
            "city": "Oro Valley",
            "state": "AZ",
            "postal_code": "857551963",
            "country_code": "US",
            "telephone_number": "601-466-9495",
            "fax_number": "601-469-9965",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7901 4th St N Ste 300",
            "address_purpose": "LOCATION",
            "city": "St Petersburg",
            "state": "FL",
            "postal_code": "337024399",
            "country_code": "US",
            "telephone_number": "601-466-9495",
            "fax_number": "601-469-9965",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "530B Harkle Rd Ste 100",
            "address_purpose": "LOCATION",
            "city": "Santa Fe",
            "state": "NM",
            "postal_code": "875054739",
            "country_code": "US",
            "telephone_number": "601-466-9495",
            "fax_number": "601-469-9965",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SPECTRUM THE OTHER CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-17",
        "last_updated": "2021-04-06",
        "certification_date": "2021-04-06",
        "status": "A",
        "authorized_official_last_name": "PACE",
        "authorized_official_first_name": "STACIE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER/DIRECTOR",
        "authorized_official_telephone_number": "601-466-9495",
        "authorized_official_credential": "CNP"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Acute Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 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.