Christal R Stark, RN, MSN, C-PNP

Primary specialty

Pediatric Clinical Nurse SpecialistTaxonomy code 364SP0200X

License

67293 Issued in WV

Practice address

400 Fairview Heights Rd
Suite 302
Summersville, WV 26651-9308

Phone

(304) 872-7063

Fax

(304) 872-7080

NPI assigned

Dec 12, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Certified Pediatric Nurse Practitioner, Master of Science - Nursing, Registered Nurse

State licenses

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

{
    "created_epoch": "1197417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1407801600000",
    "number": "1639352602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 FAIRVIEW HEIGHTS RD",
            "address_2": "SUITE 302",
            "city": "SUMMERSVILLE",
            "state": "WV",
            "postal_code": "266519308",
            "telephone_number": "304-872-7063",
            "fax_number": "304-872-7080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 FAIRVIEW HEIGHTS RD",
            "address_2": "SUITE 302",
            "city": "SUMMERSVILLE",
            "state": "WV",
            "postal_code": "266519308",
            "telephone_number": "304-872-7063",
            "fax_number": "304-872-7080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STARK",
        "first_name": "CHRISTAL",
        "middle_name": "R",
        "credential": "RN, MSN, C-PNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-12-12",
        "last_updated": "2014-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "364SP0200X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Pediatrics",
            "state": "WV",
            "license": "67293",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "67293",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• David Griffin Stone, B.S.
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• Conley Stout, MD

• Pediatric Clinical Nurse Specialist in Summersville, WV
• Providers in Summersville, WV by specialty
• Pediatric Clinical Nurse Specialist in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2014; 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.