Brandi L Stacy, APRN
Individual provider Active NPI Nurse Practitioner · Hickman, KY
NPI 1760722144 · NPPES record last updated Jun 21, 2024
Key facts
- NPI
- 1760722144
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 3007706 (KY)
- Practice address
- 2003 S 7TH St
Hickman, KY 42050-1841 - Phone
- (270) 236-3337
- Fax
- (270) 236-3340
- NPI assigned
- Feb 22, 2013
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 11
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Pinelake Physician Practice LLC
Practice addresses (Care Compare)
2003 S 7TH St
Hickman, KY 42050-1841
Phone (270) 236-3337
Hospital & facility affiliations
- Jackson Purchase Medical Center
- Baptist Memorial Hospital Union City
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130325000529 | KY | Practitioner - Nurse Practitioner | 8022253921 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3007706 | KY | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mercy Health Physicians Kentucky Specialty Care LLC | Nurse Practitioner | Current |
Accepting new patients |
| Telos Health Systems Ky LLC | Current |
Accepting new patients | |
| Pinelake Physician Practice, LLC | Current | Accepting new patients | |
| Mercy Health Physicians Kentucky Specialty Care LLC | Current |
Accepting new patients | |
| Pinelake Physician Practice LLC | Current |
Accepting new patients | |
| Pinelake Physician Practice, LLC | Current |
Accepting new patients | |
| Pinelake Physician Practice, LLC | Nurse Practitioner | Past | Accepting new patients |
Locations
1004 Holiday Ln
Fulton, KY 42041
Phone (270) 472-1971
2003 S 7th St
Hickman, KY 42050
Phone (270) 236-3202
3500 Good Samaritan Way
Louisville, KY 40299
Phone (502) 267-7403
1029 Medical Center Cir
Ste 401
Mayfield, KY 42066
Phone (270) 251-4590
401 Indiana Ave
Mayfield, KY 42066
Phone (270) 247-0200
225 Medical Center Dr
Ste 101
Paducah, KY 42003
Phone (270) 441-4357
1532 Lone Oak Rd
Ste 245
Paducah, KY 42003
Phone (270) 538-5537
1532 Lone Oak Rd
Ste 320
Paducah, KY 42003
Phone (270) 415-3830
1530 Lone Oak Rd
Paducah, KY 42003
Phone (270) 444-2444
330 Seven Springs Way
Brentwood, TN 37027
Phone (615) 920-7780
Interoperability endpoints
- brandi.stacy.1@19475.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 3007706 | KY | |
| Nurse Practitioner | 363L00000X | 3007706 | KY | Yes |
Addresses
Primary practice location
2003 S 7TH St
Hickman, KY 42050-1841
Mailing address
330 Seven Springs Way
Brentwood, TN 37027-5098
Phone (615) 920-7000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7100237310 | Medicaid | KY |
Other names
- Brandi L Jackson
Other providers in Hickman, KY
- Parkway Regional Medical Clinic, Inc
- Pinelake Physician Practice LLC
- Purchase District Health Department
- Purchase District Health Dept
- Rumfelt Drug Inc
All providers in Hickman, KY · Nurse Practitioner in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 21, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.