Stacie A Sidebotham, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

5004935 Issued in NC

Practice address

405 Owen Dr
Fayetteville, NC 28304-3411

Phone

(910) 323-3183

Fax

(910) 323-5488

NPI assigned

Nov 1, 2010

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 NC

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

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: stacie.sidebotham@mafp.eclinicaldirectplus.com

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.

• Medical Arts Family Practice, PA

  • Family Medicine Physician
  • Fayetteville, NC
  • NPI 1831168103
  Medicare reassignment NPD
• Cape Fear Valley Health Medical Group LLC

  • Family Medicine Physician
  • Fayetteville, NC
  • NPI 1558203232
  NPD (past)

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

{
    "created_epoch": "1288569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459987200000",
    "number": "1710287263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "413 OWEN DR",
            "address_2": "STE 201",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043490",
            "telephone_number": "910-323-9111",
            "fax_number": "910-484-2535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 OWEN DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043411",
            "telephone_number": "910-323-3183",
            "fax_number": "910-323-5488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIDEBOTHAM",
        "first_name": "STACIE",
        "middle_name": "A",
        "name_prefix": "Mrs.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-11-01",
        "last_updated": "2016-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5004935",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daphne S Shuler-Thurman, LCAS-A
• Amanda M Shultz, OTRL
• April Ann Shumard
• Joseph L Shurtleff, DDS
• Hunnain Siddiqui, PHARMD
• Deborah Jean Sides, NP
• Kellsie Rae Siebach, LMFT
• Kate Sifuentes
• Breanna Sigler, PHARMD
• Sigma Solutions, PLLC

• Family Nurse Practitioner in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Family Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2016; 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.