Active NPI
Stacy L Justice, FNP-BC
- Family Nurse Practitioner
- Logan, WV
National Provider Identifier
1699076547
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 62349
- Practice address
- 557 Main St
Logan, WV 25601-3809 - Phone
- (304) 752-3435
- NPI assigned
- Nov 9, 2010
- Last updated
- Jan 17, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 62349 | WV | |
| Family Nurse Practitioner | 363LF0000X | 62349 | WV | Primary |
Addresses
Primary practice location
557 Main St
Logan, WV 25601-3809
Mailing address
PO Box 390
Huntington, WV 25708-0390
Phone (304) 429-1088
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Nurse Practitioner
- Education
- Other, 2010
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
705 Washington St
Ravenswood, WV 26164-1729
Phone (304) 868-6000
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 62349 | WV | MD | Family Nurse Practitioner |
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1289260800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1516147200000",
"number": "1699076547",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 390",
"city": "HUNTINGTON",
"state": "WV",
"postal_code": "257080390",
"telephone_number": "304-429-1088",
"fax_number": "304-696-1623"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "557 MAIN ST",
"city": "LOGAN",
"state": "WV",
"postal_code": "256013809",
"telephone_number": "304-752-3435"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JUSTICE",
"first_name": "STACY",
"middle_name": "L",
"credential": "FNP-BC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-11-09",
"last_updated": "2018-01-17",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "WV",
"license": "62349",
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "WV",
"license": "62349",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Logan, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2018; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.