Stacee Marie Gibson, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

TCA518 Issued in KY

Practice address

400 E College St
Georgetown, KY 40324-1628

Phone

(859) 274-2128

NPI assigned

May 31, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Ms. Stacee Maire Roush Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Georgetown College, Inc

  dba Georgetown Sports Medicine

  • General Practice Physician
  • Georgetown, KY
  • NPI 1285109744
  NPD (past) Authorized official

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

{
    "created_epoch": "1496188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1496188800000",
    "number": "1699203901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4146 WINNEPEG CT",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405155705",
            "telephone_number": "859-274-2128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 E COLLEGE ST",
            "city": "GEORGETOWN",
            "state": "KY",
            "postal_code": "403241628",
            "telephone_number": "859-274-2128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "STACEE",
        "middle_name": "MARIE",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-05-31",
        "last_updated": "2017-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "KY",
            "license": "TCA518",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACEE",
            "last_name": "ROUSH",
            "middle_name": "MAIRE",
            "prefix": "MS.",
            "credential": "ATC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Georgetown-Scott County Ambulance Service (Georgetown-Scott County EMS)
• Gerogetown Community Hospital LLC
• Anne-Claire Gibson, RBT
• Heath Martin Gibson, PA-C
• Jessica N Gibson, PT, DPT
• Dudley Brewer Glass, Jr., D.M.D.
• Dustin Michael Golebieski, DPT
• Michael Goodwin, D.O.
• Shon L Goodwin, M.S.
• Janette A Graham, PT

• Athletic Trainer in Georgetown, KY
• Providers in Georgetown, KY by specialty
• Athletic Trainer in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2017; 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.