Individual provider Active NPI

Stacey Green Prather, P.A.-C

  • Physician Assistant
  • Lafayette, LA
National Provider Identifier
1679856751
Registry record updated Jun 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA200502 Issued in LA
Practice address
108 Rue Louis Xiv
Lafayette, LA 70508-5739
Phone
(337) 235-8007
Fax
(337) 235-8008
NPI assigned
Sep 24, 2011
Last updated
Jun 15, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA200502 LA Primary
Physician Assistant 363A00000X 200502 LA

Addresses

Primary practice location

108 Rue Louis Xiv
Lafayette, LA 70508-5739

Mailing address

108 Rue Louis Xiv
Lafayette, LA 70508-5739
Phone (337) 889-3074

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA
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
I20120111000932 LA Practitioner - Physician Assistant 2163699323 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

108 Rue Louis Xiv
Lafayette, LA 70508-5739
Phone (337) 235-8007

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science, Physician Assistant

State licenses

LicenseStateTypeSpecialty
200502LAMDPhysician Assistant
PA200502LAMDPhysician Assistant

Organizations & group practices 1

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.

Hospital & facility affiliations 4

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

NPI Registry JSON

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

{
    "created_epoch": "1316822400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686787200000",
    "number": "1679856751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "108 RUE LOUIS XIV",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705085739",
            "telephone_number": "337-889-3074",
            "fax_number": "337-889-3112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "108 RUE LOUIS XIV",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705085739",
            "telephone_number": "337-235-8007",
            "fax_number": "337-235-8008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRATHER",
        "first_name": "STACEY",
        "middle_name": "GREEN",
        "name_prefix": "Ms.",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-24",
        "last_updated": "2023-06-15",
        "certification_date": "2023-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "LA",
            "license": "PA200502",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "LA",
            "license": "200502",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lafayette, LA

Sources for this page

Verify at the official NPI Registry.