Stacey L Whitaker, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA1494 Issued in AL

Practice address

2008 Wynfield Dr
Prattville, AL 36067-7157

Phone

(208) 391-7280

Fax

(534) 202-4595

NPI assigned

Sep 30, 2014

Last updated

Aug 26, 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

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Ground Up Behavioral Health LLC

  dba Ground Up Behavioral Health

  • Psychiatry Physician
  • Montgomery, AL
  • NPI 1902695661
  NPD (past)
• Charleston Family Center, LLC

  • Marriage & Family Therapist
  • Charleston, SC
  • NPI 1619939873
  NPD (past)

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

{
    "created_epoch": "1412035200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724630400000",
    "number": "1518360973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2008 WYNFIELD DR",
            "city": "PRATTVILLE",
            "state": "AL",
            "postal_code": "360677157",
            "telephone_number": "208-391-7280",
            "fax_number": "534-202-4595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2008 WYNFIELD DR",
            "city": "PRATTVILLE",
            "state": "AL",
            "postal_code": "360677157",
            "telephone_number": "208-391-7280",
            "fax_number": "534-202-4595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITAKER",
        "first_name": "STACEY",
        "middle_name": "L",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-09-30",
        "last_updated": "2024-08-26",
        "certification_date": "2024-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "ID",
            "license": "PA2812",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "TPPA773",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AL",
            "license": "PA1494",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steve Weedon, AT/LAT, M.ED
• John Taylor Weglicki, DPT
• Carrie Wells, LICSW
• Victoria Wheeler
• Kristen Whetstone
• White Chiropractic, LLC
• Amanda M White, D.C.
• Joshua P White, D.C.
• Alexandria P Wiggins
• Emily Griggs Wilkinson, DPT

• Physician Assistant in Prattville, AL
• Providers in Prattville, AL by specialty
• Physician Assistant in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.