Julie R. Stackhouse, CNM

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

71001177A Issued in IN

Practice address

2414 E State Blvd
Suite 101
Fort Wayne, IN 46805-4760

Phone

(260) 422-7455

Fax

(260) 422-0086

NPI assigned

Jan 18, 2007

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

Other identifiers 1

Other names 1

• Julie R. Mitchener Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Midwife

State licenses

Interoperability endpoints

• Direct secure messaging: julie.stackhouse.p1@direct.northshorehealth.nextgenshare.com

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580342400000",
    "number": "1942352802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6920 POINTE INVERNESS WAY STE 200",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468047934",
            "telephone_number": "260-479-3516",
            "fax_number": "260-479-3520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2414 E STATE BLVD",
            "address_2": "SUITE 101",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468054760",
            "telephone_number": "260-422-7455",
            "fax_number": "260-422-0086"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STACKHOUSE",
        "first_name": "JULIE",
        "middle_name": "R.",
        "credential": "CNM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-18",
        "last_updated": "2020-01-30",
        "certification_date": "2020-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "IN",
            "license": "71001177A",
            "primary": true
        },
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "IN",
            "license": "09000127A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200847020",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JULIE",
            "last_name": "MITCHENER",
            "middle_name": "R.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• St. Joseph Health System, LLC
• St. Joseph Township EMS
• St. Vincent Hospital and Health Care Center, Inc.
• Jeff S Stachera, LMHC, MS ED
• Brent A Stachler, LMFT, MAC, MS ED
• Kara N Stackhouse
• Dana L Staddon, FNP-C
• Lynn H Stafford, DPM
• Ashley Stalling, RBT
• Jillian Christine Stalling, MD

• Nurse Practitioner in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Nurse Practitioner in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 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.

Verify at the official NPI Registry.