Stacey Lyn Williams, CPNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

R119208 Issued in MD

Practice address

1122 Gypsy LN W
Towson, MD 21286-1404

Phone

(443) 243-6267

NPI assigned

Mar 13, 2019

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

Medicare fee-for-service enrollment

Enrolled in MD

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

Certified Pediatric Nurse Practitioner, Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: swilliams43189@direct.kennedykrieger.org

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.

• Maryland Family Care, Inc.

  • Family Medicine Physician
  • Baltimore, MD
  • NPI 1598718256
  Medicare reassignment NPD

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

{
    "created_epoch": "1552435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552435200000",
    "number": "1699234393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1122 GYPSY LN W",
            "city": "TOWSON",
            "state": "MD",
            "postal_code": "212861404",
            "telephone_number": "443-243-6267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1122 GYPSY LN W",
            "city": "TOWSON",
            "state": "MD",
            "postal_code": "212861404",
            "telephone_number": "443-243-6267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "STACEY",
        "middle_name": "LYN",
        "credential": "CPNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-03-13",
        "last_updated": "2019-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MD",
            "license": "R119208",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jonah Williams
• Kathryn L. Williams, C.R.N.P.
• Latea Williams
• Latrina Williams
• Raina Williams
• Theresa Brewer Williams, P.T.
• Jennifer Paige Williamson, RD, MD, CNSC, LDN
• Dale Wayne Willis, MSW
• Nia Willis, LGPAT
• Wanda Willoughby, LMSW

• Pediatric Nurse Practitioner in Towson, MD
• Providers in Towson, MD by specialty
• Pediatric Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2019; 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.