Stefanie Davis, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

SP013719 Issued in PA

Practice address

210 Henderson Ave
Ridley Park, PA 19078-1526

Phone

(484) 557-8509

NPI assigned

Aug 14, 2015

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

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

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

{
    "created_epoch": "1439510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1439769600000",
    "number": "1619343597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 HENDERSON AVE",
            "city": "RIDLEY PARK",
            "state": "PA",
            "postal_code": "190781526",
            "telephone_number": "484-557-8509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 HENDERSON AVE",
            "city": "RIDLEY PARK",
            "state": "PA",
            "postal_code": "190781526",
            "telephone_number": "484-557-8509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "STEFANIE",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-08-14",
        "last_updated": "2015-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "PA",
            "license": "SP013719",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "PA",
            "license": "SP013719",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brianna Costa, MS, CEP
• Costa's Apothecary, Inc
• D. P. Dodds Associates, Inc. (Conner-Williams Nursing Home)
• Brian P Daly, LPC
• Jeffrey T Darnall, MD
• Jacques E Decaestecker, MD
• Del Chesco Urology
• Barkwende M Delma
• Dahnelle Mamayea Dennis, FNP
• Divine Providence Village

• Family Nurse Practitioner in Ridley Park, PA
• Providers in Ridley Park, PA by specialty
• Family Nurse Practitioner in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2015; 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.