Sally Magdalen Stark, NP

Primary specialty

Women's Health Nurse PractitionerTaxonomy code 363LW0102X

License

57995 Issued in CO

Practice address

110 W ENT Ave
Peterson Afb, CO 80914-1595

Phone

(719) 556-0510

Fax

(866) 867-7926

NPI assigned

Nov 18, 2005

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

Nurse Practitioner

State licenses

Interoperability endpoints

• Direct secure messaging: sally.stark.p2@direct.usppny.nextgenshare.com

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

{
    "created_epoch": "1132272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1332806400000",
    "number": "1528040995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 W ENT AVENUE",
            "city": "PETERSON AFB",
            "state": "CO",
            "postal_code": "809141595",
            "telephone_number": "719-556-0510",
            "fax_number": "866-867-7926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 W ENT AVE",
            "city": "PETERSON AFB",
            "state": "CO",
            "postal_code": "809141595",
            "telephone_number": "719-556-0510",
            "fax_number": "866-867-7926"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STARK",
        "first_name": "SALLY",
        "middle_name": "MAGDALEN",
        "name_prefix": "Ms.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-18",
        "last_updated": "2012-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LW0102X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Women's Health",
            "state": "CO",
            "license": "57995",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amy Lynn Ruff, NP
• Melissa Runge, M.D.
• Amber Lynn Scouton
• Phillip John Sheridan
• Brian David Sherman, PHARMD
• James Neal Sutherland, DDS
• Jay Stephen Taylor, DDS, MS
• Ross James Thompson, DDS
• Karen L Travers, MD
• Edward Joseph Tucholski Jr., DDS

• Women's Health Nurse Practitioner in Peterson Afb, CO
• Providers in Peterson Afb, CO by specialty
• Women's Health Nurse Practitioner in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2012; 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.