Stacey M. Smith, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

103070 Issued in NC

Practice address

2010 Baldwin LN
Winston Salem, NC 27103-5846

Phone

(336) 277-1717

NPI assigned

Feb 27, 2009

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 names 1

• Stacey Renee Moose Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1235692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603843200000",
    "number": "1972743185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 751803",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282751803",
            "telephone_number": "336-277-1717"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2010 BALDWIN LN",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271035846",
            "telephone_number": "336-277-1717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "STACEY",
        "middle_name": "M.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-02-27",
        "last_updated": "2020-10-28",
        "certification_date": "2020-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "VA",
            "license": "0110003000",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "103070",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ssmith177427@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "2010 Baldwin Ln",
            "city": "Winston Salem",
            "state": "NC",
            "country_code": "US",
            "postal_code": "271035846",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "STACEY",
            "last_name": "MOOSE",
            "middle_name": "RENEE",
            "credential": "PA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Rachel Hinshaw Smith, CRNA
• Rebecca J Smith, MS
• Savannah Kyle Smith
• Sharon Teresa Smith, FNP-C
• Stacey Booe Smith
• Stephanie N Smith
• Stephanie Sweet Smith, MSN, PMHNP
• Steven Ross Smith, DDS
• Steven W. Smith, M.D.
• Timothy Earl Smith, MD

• Physician Assistant in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 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.