Stacy Yohannan

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

AP144895 Issued in TX

Practice address

4725 Wellington St
Greenville, TX 75401-4945

Phone

(469) 320-1267

Fax

(945) 242-8020

NPI assigned

Sep 15, 2021

Last updated

Dec 6, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Stacy Georgekutty Former name

Medicare fee-for-service enrollment

Enrolled in TX

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

Specialty

Nurse Practitioner

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Segue Health of Texas PLLCGroup PAC ID 8921400953, 24 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Segue Health of Texas PLLC

  • Family Medicine Physician
  • Azle, TX
  • NPI 1215510763
  Medicare reassignment Care Compare group NPD
• Vascular Institute Texas, PLLC

  • Specialist
  • Garland, TX
  • NPI 1326787524
  NPD

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

{
    "created_epoch": "1631664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670284800000",
    "number": "1861162414",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 29650, DEPT# 880579",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "85038",
            "telephone_number": "480-626-1746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4725 WELLINGTON ST",
            "city": "GREENVILLE",
            "state": "TX",
            "postal_code": "754014945",
            "telephone_number": "469-320-1267",
            "fax_number": "945-242-8020"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "630 N Bishop Ave",
            "address_purpose": "LOCATION",
            "city": "Dallas",
            "state": "TX",
            "postal_code": "752084335",
            "country_code": "US",
            "telephone_number": "469-320-1267",
            "fax_number": "945-242-8020",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1919 S Shiloh Rd Ste 400",
            "address_purpose": "LOCATION",
            "city": "Garland",
            "state": "TX",
            "postal_code": "750428211",
            "country_code": "US",
            "telephone_number": "469-320-1267",
            "fax_number": "945-242-8020",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "YOHANNAN",
        "first_name": "STACY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-09-15",
        "last_updated": "2022-12-06",
        "certification_date": "2022-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP144895",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "AP144895",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACY",
            "last_name": "GEORGEKUTTY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Min Sheng Wu, M.D.
• Heather Deann Wyatt, FNP-C
• Lori C Wyatt, MD
• Gabriel J Wymore
• Rehan Saeed Yazdani, MD
• Kursti Young, LVN
• Mohammed Youssef, MD
• Amanda Zachary, CCC-SLP
• Xavier Zamora, DPM
• Zapata Women's Health Center, P.C.

• Nurse Practitioner in Greenville, TX
• Providers in Greenville, TX by specialty
• Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 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.
• 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.