Active NPI
Stacy Phillips
- Nutritionist
- Incline Village, NV
National Provider Identifier
1770098394
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nutritionist
- License
- NU100000198
- Practice address
- 571 Rockrose CT
Incline Village, NV 89451-8300 - Phone
- (805) 704-7193
- NPI assigned
- Dec 5, 2017
- 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 |
|---|---|---|---|---|
| Nutritionist | 133N00000X | NU100000198 | DC | Primary |
Addresses
Primary practice location
571 Rockrose CT
Incline Village, NV 89451-8300
Mailing address
PO Box 124
Moffett Field, CA 94035-0124
Phone (805) 704-7193
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NU100000198 | DC | MD | Nutritionist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1512432000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1595808000000",
"number": "1770098394",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 124",
"city": "MOFFETT FIELD",
"state": "CA",
"postal_code": "940350124",
"telephone_number": "805-704-7193"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "571 ROCKROSE CT",
"city": "INCLINE VILLAGE",
"state": "NV",
"postal_code": "894518300",
"telephone_number": "805-704-7193"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHILLIPS",
"first_name": "STACY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-12-05",
"last_updated": "2020-07-27",
"certification_date": "2020-07-27",
"status": "A"
},
"taxonomies": [
{
"code": "133N00000X",
"taxonomy_group": "",
"desc": "Nutritionist",
"state": "DC",
"license": "NU100000198",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Incline Village, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.