Stacy D Martin, CRNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

RN134146 Issued in AZ

Practice address

1566 Pea Ridge Rd
Scottsville, KY 42164-7702

Phone

(928) 266-7022

NPI assigned

May 3, 2006

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

• Ms. Stacy Martin Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

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.

• Inlet Physical Medicine LLC

  • Interventional Pain Medicine Physician
  • Murrells Inlet, SC
  • NPI 1255603403
  NPD (past)
• River Cities Community Clinic Inc.

  • Primary Care Clinic/Center
  • Bullhead City, AZ
  • NPI 1144387713
  NPD (past)

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

{
    "created_epoch": "1146614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1295222400000",
    "number": "1992763569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1566 PEA RIDGE RD",
            "city": "SCOTTSVILLE",
            "state": "KY",
            "postal_code": "421647702",
            "telephone_number": "928-266-7022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1566 PEA RIDGE RD",
            "city": "SCOTTSVILLE",
            "state": "KY",
            "postal_code": "421647702",
            "telephone_number": "928-266-7022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTIN",
        "first_name": "STACY",
        "middle_name": "D",
        "name_prefix": "Ms.",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-03",
        "last_updated": "2011-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "AZ",
            "license": "134146",
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "AZ",
            "license": "RN134146",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACY",
            "last_name": "MARTIN",
            "prefix": "MS.",
            "credential": "CRNP/ARNP",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• James Robert Madon III, PHARMD.
• Dennis Makokha, MA
• Gloria Marroquin, M.D.
• Angela Brooke Marsh, APRN
• Paige Pride Marsh, D.M.D
• Alicia Mathew, FNP
• James McCandless
• Amanda McGeorge, MD
• Krystal McKain, APRN
• Amy Lynn Meador, RDLD

• Pediatric Nurse Practitioner in Scottsville, KY
• Providers in Scottsville, KY by specialty
• Pediatric Nurse Practitioner in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2011; 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.