Stacy Jervis, FNP-BC, MED, CNRN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

53-76375-032 Issued in KS

Practice address

2508 Edgemont Dr Ste 2
Arkansas City, KS 67005-3844

Phone

(620) 442-7120

NPI assigned

Sep 1, 2014

Last updated

Feb 7, 2022By 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 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in KS, TX2 enrollments

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 2

Specialty

Nurse Practitioner

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Hospital & facility affiliations

• Interim Healthcare of Wichita Home health agency, Wichita, KS, CCN 177090

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Education, Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/FJHFCD
• Direct secure messaging: stacey.jervis.1@25155.direct.athenahealth.com

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.

• Abbas Family Medicine

  • Family Nurse Practitioner
  • Arkansas City, KS
  • NPI 1083286728
  Medicare reassignment NPD
• DHHS PHS Naihs Crownpoint Hospital

  • General Acute Care Hospital
  • Crownpoint, NM
  • NPI 1114960093

  TX

  Medicare reassignment NPD
• TLC Family Health

  • Family Nurse Practitioner
  • Arkansas City, KS
  • NPI 1194505776
  NPD
• Pueblo Pintado Clinic

  • Clinic/Center
  • Cuba, NM
  • NPI 1023051133
  NPD
• Thoreau Clinic

  • Clinic/Center
  • Thoreau, NM
  • NPI 1679516702
  NPD
• Neurology Consultants of Kansas LLC

  • Neurology Physician
  • Wichita, KS
  • NPI 1760474936
  NPD (past)
• Pawnee IHS Pharmacy

  • Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
  • Pawnee, OK
  • NPI 1124178017
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Interim Health Care of Wichita Inc

  dba Interim Health Care

  • Home Health Agency
  • Wichita, KS
  • NPI 1548264229
  Care Compare affiliation

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

{
    "created_epoch": "1409529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644192000000",
    "number": "1538569199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2508 EDGEMONT DR STE 2",
            "city": "ARKANSAS CITY",
            "state": "KS",
            "postal_code": "670053844",
            "telephone_number": "620-442-7120",
            "fax_number": "620-442-7121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2508 EDGEMONT DR STE 2",
            "city": "ARKANSAS CITY",
            "state": "KS",
            "postal_code": "670053844",
            "telephone_number": "620-442-7120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JERVIS",
        "first_name": "STACY",
        "name_prefix": "Ms.",
        "credential": "FNP-BC, MED, CNRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-09-01",
        "last_updated": "2022-02-07",
        "certification_date": "2022-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KS",
            "license": "53-76375-032",
            "primary": true
        },
        {
            "code": "163WN0800X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Neuroscience",
            "state": "KS",
            "license": "14-127265-032",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "KA5478001",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jose L Hinojosa, M.D.
• Brett Michael House, DC
• Heather L Irving, APRN
• Teresa Lynne Jackson, FNP
• Amber Jennings
• Julie C Jones, PA-C
• K and D Pharmacy LLC
• Kamran Shahzada, M.D.
• Adam D Keesling, MD
• Mindy S Kile, PA

• Family Nurse Practitioner in Arkansas City, KS
• Providers in Arkansas City, KS by specialty
• Family Nurse Practitioner in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2022; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.