Stacy Nicole Kisor

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SI 60298212 Issued in WA

Practice address

5516 S Fort Apache Rd Ste 130
Las Vegas, NV 89148-7679

Phone

(702) 641-8255

NPI assigned

Dec 14, 2012

Sex

Female

Sole proprietor

Yes

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 NV

Enrollment records 1

Specialty

Qualified Speech Language Pathologist

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Speech Therapy Center of Excellence, Inc.

  • Speech-Language Pathologist
  • Las Vegas, NV
  • NPI 1679620934
  Medicare reassignment NPD

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

{
    "created_epoch": "1355443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582675200000",
    "number": "1770829061",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5516 S FORT APACHE RD STE 130",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891487679",
            "telephone_number": "702-641-8255",
            "fax_number": "702-399-8255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5516 S FORT APACHE RD STE 130",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891487679",
            "telephone_number": "702-641-8255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KISOR",
        "first_name": "STACY",
        "middle_name": "NICOLE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-12-14",
        "last_updated": "2020-02-26",
        "certification_date": "2020-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "WA",
            "license": "SI 60298212",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tessa Anne Kiser
• Alyssa Kiserow
• Hussain Kishkish
• Kismet Recovery PLLC
• Anna Margarita Petilla Kison, RN
• Jason A Kiss, PSYD, LP
• Steven John Kiss, PA-C
• Tana Kissinger
• Ryan N Kissling, DC
• Jacob Paul Kissman, PT, DPT, CSCS

• Speech-Language Pathologist in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Speech-Language Pathologist in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.