Kendall C Stacker

Primary specialty

Non-emergency Medical Transport (VAN)Taxonomy code 343900000X

Practice address

2745 Brookmeadow Dr
Belleville, IL 62221-7116

Phone

(618) 257-3090

Fax

(618) 257-3090

NPI assigned

Nov 21, 2013

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1384992000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1384992000000",
    "number": "1831529239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2745 BROOKMEADOW DR",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "62221",
            "telephone_number": "618-257-3090",
            "fax_number": "618-257-3090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2745 BROOKMEADOW DR",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622217116",
            "telephone_number": "618-257-3090",
            "fax_number": "618-257-3090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STACKER",
        "first_name": "KENDALL",
        "middle_name": "C",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-11-21",
        "last_updated": "2013-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "343900000X",
            "taxonomy_group": "",
            "desc": "Non-emergency Medical Transport (VAN)",
            "state": "IL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Matt Raymod St. Eve, D.M.D.
• Carrie Staggs, FNP-BC
• Tomario C Stamps I, MSW
• Kaitlyn Stanbridge
• Caprice Stancil-Smith, L.C.P.C.
• Kaitlyn Stanton, DMD

• Non-emergency Medical Transport (VAN) in Belleville, IL
• Providers in Belleville, IL by specialty
• Non-emergency Medical Transport (VAN) in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.