Stacy Lynn Fennell, D.O.

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

02004134A Issued in IN

Practice address

3851 Roger Brooke Dr
McHe-Emr
Fort Sam Houston, TX 78234-4501

Phone

(210) 292-7626

NPI assigned

May 23, 2011

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

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

{
    "created_epoch": "1306108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1400803200000",
    "number": "1477846582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8344 VERSAILLES SE RD",
            "city": "BRADFORD",
            "state": "OH",
            "postal_code": "453089602",
            "telephone_number": "937-974-8352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3851 ROGER BROOKE DR",
            "address_2": "MCHE-EMR",
            "city": "FORT SAM HOUSTON",
            "state": "TX",
            "postal_code": "782344501",
            "telephone_number": "210-292-7626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FENNELL",
        "first_name": "STACY",
        "middle_name": "LYNN",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-05-23",
        "last_updated": "2014-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "IN",
            "license": "02004134A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Natasha Simone Featherstone, MD
• George Feden, PH.D.
• Terrance T Fee, DPT, OCS
• Kayla Felderhoff Patterson
• Joshua Fenderson, M.D.
• Emilio Fentanes, M.D.
• David B. Ferguson, D.D.S., M.S.
• Erin Fetzer, PA-C
• Robert Freeman Fewkes, PT, DPT, MOTR/L
• Aaron D Fielden, D.O.

• General Practice Physician in Fort Sam Houston, TX
• Providers in Fort Sam Houston, TX by specialty
• General Practice Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2014; 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.