Stacy A Brandt, APRN-NP

Key facts

NPI

1962874149

Entity type

Individual (NPI type 1)

Primary specialty

Family Nurse Practitioner 363LF0000X

License

CP000992 (SD)

Practice address

3515 Broadway Ave
Yankton, SD 57078-4917

Phone

(605) 668-3100

NPI assigned

Oct 27, 2015

Sex

Female

Sole proprietor

Yes

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

Yes

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 22, 2021.

{
    "created_epoch": "1445904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1619049600000",
    "number": "1962874149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3515 BROADWAY AVE",
            "city": "YANKTON",
            "state": "SD",
            "postal_code": "570784917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3515 BROADWAY AVE",
            "city": "YANKTON",
            "state": "SD",
            "postal_code": "570784917",
            "telephone_number": "605-668-3100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRANDT",
        "first_name": "STACY",
        "middle_name": "A",
        "credential": "APRN-NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-10-27",
        "last_updated": "2021-04-22",
        "certification_date": "2021-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "SD",
            "license": "CP000992",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NE",
            "license": "111925",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Yankton, SD

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• Alison Boughn, PHD
• Justin Lee Boulware
• Collette Bowman
• Shanna Brahmer
• Marlin R Braun, DC
• Sarah Braxton, CSW-PIP
• Kevin B Bray, MD
• Susan Jean Brende, OTR/L
• Brenna Sokol, LLC

All providers in Yankton, SD · Family Nurse Practitioner in South Dakota