Stacie Pace, AGACNP, AGPCNP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

879432 Issued in MS

Practice address

709 Hardy St
Hattiesburg, MS 39401-3666

Phone

(601) 466-9495

Fax

(601) 469-9965

NPI assigned

Jan 17, 2014

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 5

Addresses

Other identifiers 1

Other names 1

• Stacie Park Former name

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: stacie@otherclinic.kareodirect.com

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.

• Spectrum the Other Clinic

  • Nurse Practitioner
  • Hattiesburg, MS
  • NPI 1447893888
  NPD Authorized official

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

{
    "created_epoch": "1389916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699315200000",
    "number": "1528480035",
    "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": "601-466-9495"
        },
        {
            "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": "270 Trace Colony Park Dr Ste B",
            "address_purpose": "LOCATION",
            "city": "Ridgeland",
            "state": "MS",
            "postal_code": "391578810",
            "country_code": "US",
            "telephone_number": "601-643-9708",
            "fax_number": "601-469-9965",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1846 E Innovation Drive",
            "address_purpose": "LOCATION",
            "city": "Oro Valley",
            "state": "AZ",
            "postal_code": "85755",
            "country_code": "US",
            "telephone_number": "601-466-9495",
            "fax_number": "601-469-9965",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "7120 E Orchard Rd Ste 307",
            "address_purpose": "LOCATION",
            "city": "Centennial",
            "state": "CO",
            "postal_code": "801111734",
            "country_code": "US",
            "telephone_number": "601-643-9708",
            "fax_number": "601-469-9965",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "602 Adeline St Ste C4",
            "address_purpose": "LOCATION",
            "city": "Hattiesburg",
            "state": "MS",
            "postal_code": "394013802",
            "country_code": "US",
            "telephone_number": "601-643-9708",
            "fax_number": "601-469-9965",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PACE",
        "first_name": "STACIE",
        "credential": "AGACNP, AGPCNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-01-17",
        "last_updated": "2023-11-07",
        "certification_date": "2023-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CO",
            "license": "C-APN.0100762-C-NP",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AZ",
            "license": "RNP232597",
            "primary": false
        },
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MS",
            "license": "879432",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "MS",
            "license": "879432",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MS",
            "license": "879432",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05656575",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACIE",
            "last_name": "PARK",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Alicia Pace
• Benjamin Robert Pace, M.D.
• Chase Pace, AUD
• Delane Dunaway Pace, COTA/L
• Lee Pace, FNP, OTR
• William L Pace, M.D.
• Pacific Physician Services, LLC
• Pacific Physician Services, LLC
• Pacific Physician Services, LLC
• Pacific Physician Services, LLC

• Nurse Practitioner in Hattiesburg, MS
• Providers in Hattiesburg, MS by specialty
• Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2023; 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.