Stacy Dawn Allport-Pridemore, FNP BC

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

107640 Issued in WV

Practice address

332 6TH Ave
South Charleston, WV 25303-1246

Phone

(304) 343-1950

Fax

(866) 225-4179

NPI assigned

Nov 16, 2020

Sex

Female

Sole proprietor

No

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.

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  WV

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• Geps Physician Group of West Virginia PC

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• Alignmed Partners, PC

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  • NPI 1881109452

  WV

  Medicare reassignment NPD
• Stonerise Home Health Services LLC

  • Home Health Agency
  • Charleston, WV
  • NPI 1235529595
  NPD (past)

Medicare fee-for-service enrollment

Enrolled in WV

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

Practice roles

Locations

• Mrs. Stacy Dawn Allport Former name

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Nov 19, 2020.

{
    "created_epoch": "1605484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605744000000",
    "number": "1649872425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "332 6TH AVE",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253031246",
            "telephone_number": "304-343-1950",
            "fax_number": "866-225-4179"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "332 6TH AVE",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253031246",
            "telephone_number": "304-343-1950",
            "fax_number": "866-225-4179"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ALLPORT-PRIDEMORE",
        "first_name": "STACY",
        "middle_name": "DAWN",
        "name_prefix": "Mrs.",
        "credential": "FNP BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-16",
        "last_updated": "2020-11-19",
        "certification_date": "2020-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WV",
            "license": "107640",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACY",
            "last_name": "ALLPORT",
            "middle_name": "DAWN",
            "prefix": "MRS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Anmar Naser Alrabadi, M.D
• Alternative Health Solutions LLC
• Daphany Amick

• All providers in South Charleston, WV
• Nurse Practitioner in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2020; 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.