Active NPI
Stacy Rae Andreacchio, FPMHNP
- Psychiatric/Mental Health Nurse Practitioner
- Meridian, MS
National Provider Identifier
1700865235
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner
- License
- R828589
- Practice address
- 5004 Highway 39 N
Meridian, MS 39301-1021 - Phone
- (601) 693-8307
- Fax
- (601) 693-6794
- NPI assigned
- Jan 12, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | R828589 | MS | Primary |
Addresses
Primary practice location
5004 Highway 39 N
Meridian, MS 39301-1021
Mailing address
PO Box 8068
Meridian, MS 39303-8068
Phone (601) 693-8307
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 08903768 | Medicaid | MS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MS
- 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, 2003
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
5004 Hwy 39 N
Meridian, MS 39301-1021
Phone (601) 693-8307
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- 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 and National Provider Directory roles.
-
- Psychologist
- Meridian, MS
- NPI 1336335546
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137024000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1211155200000",
"number": "1700865235",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 8068",
"city": "MERIDIAN",
"state": "MS",
"postal_code": "393038068",
"telephone_number": "601-693-8307",
"fax_number": "601-639-6794"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5004 HIGHWAY 39 N",
"city": "MERIDIAN",
"state": "MS",
"postal_code": "393011021",
"telephone_number": "601-693-8307",
"fax_number": "601-693-6794"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDREACCHIO",
"first_name": "STACY",
"middle_name": "RAE",
"credential": "FPMHNP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-01-12",
"last_updated": "2008-05-19",
"status": "A"
},
"taxonomies": [
{
"code": "363LP0808X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Psychiatric/Mental Health",
"state": "MS",
"license": "R828589",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "08903768",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Meridian, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2008; 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.