Individual provider Active NPI

Stacee Lyders, CPNP-PC

  • Pediatric Nurse Practitioner
  • Tucson, AZ
National Provider Identifier
1548804206
Registry record updated Jun 25, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
228942 Issued in AZ
Practice address
2222 N Craycroft Rd Ste 150
Tucson, AZ 85712-2816
Phone
(520) 202-3488
Fax
(520) 202-3486
NPI assigned
Nov 5, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 228942 AZ Primary

Addresses

Primary practice location

2222 N Craycroft Rd Ste 150
Tucson, AZ 85712-2816

Mailing address

4801 E Broadway Blvd Ste 251
Tucson, AZ 85711-2700
Phone (520) 382-1085

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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

Enrollment IDStateProvider typePAC IDDetails
I20200128002592 AZ Practitioner - Nurse Practitioner 7618303330 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
228942AZMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Arizona Community Physicians PC Nurse Practitioner CurrentSince Jan 24, 2020 Accepting new patients
Arizona Community Physician PC CurrentSince Jan 24, 2020 Accepting new patients

Locations

2222 N Craycroft Rd
Ste 150
Tucson, AZ 85712
Phone (520) 202-3488

5055 E Broadway Blvd
Ste A100
Tucson, AZ 85711
Phone (520) 327-0460

2055 W Hospital Dr
Tucson, AZ 85704
Phone (520) 547-5725

Interoperability endpoints

  • Direct secure messaging: slyders18503@azacp.direct-ci.com

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1572912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782345600000",
    "number": "1548804206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4801 E BROADWAY BLVD STE 251",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857112700",
            "telephone_number": "520-382-1085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2222 N CRAYCROFT RD STE 150",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857122816",
            "telephone_number": "520-202-3488",
            "fax_number": "520-202-3486"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LYDERS",
        "first_name": "STACEE",
        "credential": "CPNP-PC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-05",
        "last_updated": "2026-06-25",
        "certification_date": "2026-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "AZ",
            "license": "228942",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucson, AZ

Sources for this page

Verify at the official NPI Registry.