Stacey Kathryn Prudich

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

5017148 Issued in NC

Practice address

3000 Rogers Rd Ste 210
Wake Forest, NC 27587-5745

Phone

(919) 385-2120

NPI assigned

Oct 28, 2022

Sex

Female

Sole proprietor

No

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

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sprudich5364@direct.medicine.duke.edu

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.

• Duke Health Integrated Practice, Inc.

  • General Practice Physician
  • Durham, NC
  • NPI 1205553369
  Medicare reassignment NPD
• Duke University Affiliated Physicians, Inc.

  • Internal Medicine Physician
  • Durham, NC
  • NPI 1316975972
  Medicare reassignment NPD
• Duke University Affiliated Physicians, Inc.

  • Family Medicine Physician
  • Durham, NC
  • NPI 1225073554
  NPD
• Duke University Affiliated Physicians, Inc.

  • Emergency Medicine Physician
  • Raleigh, NC
  • NPI 1710120795
  NPD

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

{
    "created_epoch": "1666915200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667001600000",
    "number": "1831806017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 BLOOMINGDALE DR",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275115955",
            "telephone_number": "919-357-4713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 ROGERS RD STE 210",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275875745",
            "telephone_number": "919-385-2120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRUDICH",
        "first_name": "STACEY",
        "middle_name": "KATHRYN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-10-28",
        "last_updated": "2022-10-29",
        "certification_date": "2022-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NC",
            "license": "PRUD-6TDQL",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NC",
            "license": "5017148",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Private Diagnostic Clinic PLLC
• Process Behavioral Health, PLLC
• Morgan Proffitt
• Proficient Ambulette L.L.C.
• Progressive Outreach Solutions LLC
• Shanice Pryce, PMHNP-BC
• Publix North Carolina LP
• Pure Loving Hands Home Healthcare LLC
• Quality Life Community Care
• Emelia Quao

• Pediatric Nurse Practitioner in Wake Forest, NC
• Providers in Wake Forest, NC by specialty
• Pediatric Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.