NPIMap

Individual provider Active NPI

Staci T Cownover, PA-C

  • Physician Assistant
  • Atoka, TN
National Provider Identifier
1689695595
Registry record updated May 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1191 Issued in TN
Practice address
76 Capital Way Ste C
Atoka, TN 38004-6866
Phone
(901) 840-1202
Fax
(901) 840-1204
NPI assigned
Jul 23, 2006
Last updated
May 12, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 12, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 1191 TN Primary

Addresses

Primary practice location

76 Capital Way Ste C
Atoka, TN 38004-6866

Mailing address

1211 Union Ave Ste 330
Memphis, TN 38104-6655

Other identifiers 2

IdentifierTypeStateIssuer
Q003620MedicaidTN
6007036OtherTNBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080723000660 TN Practitioner - Physician Assistant 7810060845 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Primary Care Group, LLCGroup PAC ID 0941480131, 108 clinicians

Practice addresses (Care Compare)

2961 Canada Rd
Suite 105
Lakeland, TN 38002-4893
Phone (901) 388-0115

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1191TNMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Comprehensive Primary Care PLLC Past Accepting new patients
Physicians and Allied Health Professionals Group, PA Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: scownover32808@mlh.direct-ci.com

Organizations & group practices 3

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 9

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": "1153612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747008000000",
    "number": "1689695595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1211 UNION AVE STE 330",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381046655"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "76 CAPITAL WAY STE C",
            "city": "ATOKA",
            "state": "TN",
            "postal_code": "380046866",
            "telephone_number": "901-840-1202",
            "fax_number": "901-840-1204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COWNOVER",
        "first_name": "STACI",
        "middle_name": "T",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-23",
        "last_updated": "2025-05-12",
        "certification_date": "2025-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "1191",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q003620",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "6007036",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Atoka, TN

Sources for this page

Verify at the official NPI Registry.