Stacy Diane Raverty, RN

Primary specialty

Gerontology Registered NurseTaxonomy code 163WG0600X

License

1352210 Issued in MN

Practice address

104 Meray Blvd
Mankato, MN 56001-4345

Phone

(507) 387-2037

Fax

(507) 387-2061

NPI assigned

May 21, 2026

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1779321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1779321600000",
    "number": "1700716784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 MERAY BLVD",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560014345",
            "telephone_number": "507-387-2037",
            "fax_number": "507-387-2061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 MERAY BLVD",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560014345",
            "telephone_number": "507-387-2037",
            "fax_number": "507-387-2061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAVERTY",
        "first_name": "STACY",
        "middle_name": "DIANE",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-05-21",
        "last_updated": "2026-05-21",
        "certification_date": "2026-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WG0600X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Gerontology",
            "state": "MN",
            "license": "1352210",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Gerontology Registered Nurse in Mankato, MN
• Providers in Mankato, MN by specialty
• Gerontology Registered Nurse in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2026; 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.