Stacey Louise Dault, DO

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

License

006185 Issued in AZ

Practice address

6139 S Rural Rd Ste 102
Tempe, AZ 85283-2929

Phone

(480) 846-0688

Fax

(480) 741-8650

NPI assigned

May 16, 2011

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

Other identifiers 1

Other names 1

• Dr. Stacey Louise Wetmore Former name

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Arizona College of Osteopathic Medicine Mid Western University, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: stacey.dault@401968775233540.direct.elationemr.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.

• Achieve More Sports and Wellness, PLLC

  • Primary Care Clinic/Center
  • Tempe, AZ
  • NPI 1558012021
  Medicare reassignment NPD Authorized official
• Modern Sports Medicine LLC

  • Sports Medicine (Physical Medicine & Rehabilitation) Physician
  • Sun Lakes, AZ
  • NPI 1285295089
  Medicare reassignment NPD
• Scottsdale Health and Wellness PC

  • Family Medicine Physician
  • Scottsdale, AZ
  • NPI 1912903527
  Medicare reassignment NPD
• Modern Sports Medicine LLC

  • Sports Medicine (Physical Medicine & Rehabilitation) Physician
  • Tucson, AZ
  • NPI 1609662709
  NPD

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

{
    "created_epoch": "1305504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778112000000",
    "number": "1760775357",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6085",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852466085",
            "telephone_number": "480-846-0688",
            "fax_number": "480-741-8650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6139 S RURAL RD STE 102",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "852832929",
            "telephone_number": "480-846-0688",
            "fax_number": "480-741-8650"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "22044 N 44th St Ste 120",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850506103",
            "country_code": "US",
            "telephone_number": "480-846-0688",
            "fax_number": "480-741-8650",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAULT",
        "first_name": "STACEY",
        "middle_name": "LOUISE",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-05-16",
        "last_updated": "2026-05-07",
        "certification_date": "2026-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": "AZ",
            "license": "006185",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "030026",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACEY",
            "last_name": "WETMORE",
            "middle_name": "LOUISE",
            "prefix": "DR.",
            "credential": "DO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Vicki Lynn Dart, MS
• Robert Dasilva, PHARMD
• Jason C Datta, MD
• Seth Daub, BHT
• Daughters of Thunder LLC
• David J. Jagoda MD PC
• Brennon David
• Jane Davidson
• Leslie Marie Davidson, LPC
• Tameka Shauna Davis-Busby

• Sports Medicine (Family Medicine) Physician in Tempe, AZ
• Providers in Tempe, AZ by specialty
• Sports Medicine (Family Medicine) Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2026; 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.

Verify at the official NPI Registry.