STACY MARIE NEAGLES (NPI# 1235440439) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1235440439 |
| Entity Type | Individual |
| Full Name | STACY MARIE NEAGLES |
| Credential | IDMT |
| Practice Address |
1050 Jabara Ave Goldsboro NC 27531-2310 |
| Mailing Address |
1050 Jabarrah Ave Goldsboro NC 27531-2310 |
| Practice Telephone | 9197221802 |
| Mailing Telephone | 9197221802 |
| Enumeration Date | 2010-06-23 |
| Last Update Date | 2013-01-15 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1710I1003X |
Military Health Care Provider Specialization: Independent Duty Medical Technicians |
Other Service Providers |
| Street Address |
1050 JABARA AVE |
| City | GOLDSBORO |
| State | NC |
| Zip Code | 27531-2310 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821087818 | Todd Alan Cesar | Social Worker | 1050 Jabara Ave, Seymour Johnson Afb, Goldsboro, NC 27531-2310 | 2005-10-21 |
| 1184137457 | Jason H Trinh | Pharmacist | 1050 Jabara Ave, Goldsboro, NC 27531-2310 | 2017-11-09 |
| 1184152910 | David Vincent Peter Espitia | Military Health Care Provider | 1050 Jabara Ave, Goldsboro, NC 27531-2310 | 2017-05-24 |
| 1972050920 | Brittany Denise Booker | Nurse Practitioner | 1050 Jabara Ave, Goldsboro, NC 27531-2310 | 2016-09-07 |
| 1699144923 | Matthew Keeney Williams | Physical Therapist | 1050 Jabara Ave, Goldsboro, NC 27531-2310 | 2015-09-16 |
| 1992144778 | Anthony J Meelan | Family Medicine | 1050 Jabara Ave, Goldsboro, NC 27531-2310 | 2013-06-14 |
| 1679829634 | Luke Li | Psychiatry & Neurology | 1050 Jabara Ave, Goldsboro, NC 27531-2310 | 2012-07-27 |
| 1538432018 | Elliott John Sally | Pediatrics | 1050 Jabara Ave, Sjafb, Pediatric Clinic, Goldsboro, NC 27531-2310 | 2012-02-15 |
| 1790931723 | Joshua S Swantek | Pharmacist | 1050 Jabara Ave, Seymour Johnson Afb, Goldsboro, NC 27531 | 2008-08-11 |
| 1487810800 | Timothy J Deruyter | Dentist | 1050 Jabara Ave, Seymour Johnson Afb, Goldsboro, NC 27531-2310 | 2008-08-05 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376185348 | Adam Golos | Pharmacist | 2803 Medical, N Campus Dr, Goldsboro, NC 27531 | 2019-10-11 |
| 1346747011 | Rachel Eden Leigh Palmer | Military Health Care Provider | 2803 Medical Campus Dr, Seymour Johnson Afb, NC 27531 | 2018-04-10 |
| 1689108508 | Peri Fouss | Pediatrics | 2803 Medical Campus Drive, Goldsboro, NC 27531 | 2017-04-18 |
| 1700256427 | Karen Schaefer | Psychologist | 1050 Jabara Ave., Goldsboro, NC 27531 | 2015-10-07 |
| 1679059737 | Charles Billig | Physician Assistant | 2803 Medical Campus Dr, Goldsboro, NC 27531 | 2018-07-12 |
| 1710413216 | Michael Everett Ridlehoover | Dentist | 2803 Medical Campus Drive, Seymour Johnson Afb, NC 27531 | 2017-05-04 |
| 1831173558 | Thomas Koritz Clinic | Clinic/Center | 1050 Jabara Avenue, Seymour Johnson Afb, NC 27531-2310 | 2005-12-06 |
| 1053316562 | Stephen Brian Irvin | Family Medicine | 1050 Jabarrah Ave, Seymour Johnson A F B, NC 27531-2310 | 2005-06-21 |
| 1952704975 | Andrea Sumner | Physician Assistant | 1050 Jabarrah Ave, Seymour Johnson A F B, NC 27531-2310 | 2014-10-04 |
| 1114363884 | Nathan Lee Carlson | Military Health Care Provider | 1050 Jabarrah Ave, Goldsboro, NC 27531-2310 | 2013-05-21 |
| Find all providers in zip 27531 | ||||
| Taxonomy Code | 1710I1003X |
| Grouping | Other Service Providers |
| Classification | Military Health Care Provider |
| Specialization | Independent Duty Medical Technicians |
| An Independent Duty Medical Technician (IDMT) is specially trained and educated to perform primary medical care, minor surgical services, and treatment of dental disorders for active duty military members in a variety of health care and non-health care settings worldwide under direct and indirect physician supervision. An IDMT may take medical histories, perform physical exams, order lab tests and x-rays, prescribe medications, and give immunizations. IDMTs work under the direct supervision of a physician preceptor when at home station and indirectly when assigned to a Mobile Aid Station, Mobile Medical Unit, remote site, or otherwise deployed specifically as an IDMT. An IDMT may be an experienced Aerospace Medical Service Technician who meets special task qualifications and is recommended for training by the Aerospace Medical Service Functional Manager at their Medical Treatment Facility. IDMTs maintain certification as Nationally Registered Emergency Medical Technicians and as Immunization Back-up Technicians. |
| Notes: Source: Air Force Surgeon General Office [7/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912267295 | Amber Lynn Scouton | Military Health Care Provider | 215 Bolling Dr, Goldsboro, NC 27534-5527 | 2012-05-21 |
| 1811211642 | Leasa C Novotny | Military Health Care Provider | 271 Sheridan Forest Rd Apt 1200, Goldsboro, NC 27534-7155 | 2010-03-23 |
| 1467784926 | James Blake Little | Military Health Care Provider | 300 Meadow Rd, Goldsboro, NC 27534-8759 | 2010-02-09 |
| 1184152910 | David Vincent Peter Espitia | Military Health Care Provider | 1050 Jabara Ave, Goldsboro, NC 27531-2310 | 2017-05-24 |
| 1114363884 | Nathan Lee Carlson | Military Health Care Provider | 1050 Jabarrah Ave, Goldsboro, NC 27531-2310 | 2013-05-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528415841 | Kelby Joseph Sage Durnin | Military Health Care Provider | 1020 Jabara Avenue, Seymour Johnson Afb, NC 27534 | 2016-05-17 |
| 1225425655 | Justin Wells | Military Health Care Provider | 1398 Surveyor St, Pope Army Airfield, NC 28308-2710 | 2015-04-23 |
| 1750662417 | Daryl Bradley | Military Health Care Provider | 146 Tulane Dr, Raeford, NC 28376 | 2011-09-07 |
| 1710116595 | Patrick Joseph Hunt | Military Health Care Provider | 1 Matero Dr, Ol-c 342trs, Pope, NC 28308 | 2009-07-14 |
| 1184850760 | Jose Victor Nazario | Military Health Care Provider | 628 Ed Moye Rd, La Grange, NC 28551-8888 | 2009-06-09 |
| 1962637504 | Christopher Michael Lohr | Military Health Care Provider | 102 Partridge Rd, Fayetteville, NC 28306-8235 | 2009-05-27 |
| 1417191974 | Erik William Rodriguez | Military Health Care Provider | 106 Purple Martin Pl, Fayetteville, NC 28306-8262 | 2009-04-28 |
| 1699919795 | Charles J Ross | Military Health Care Provider | 5809 Ivanhoe Ct Apt 18, Fayetteville, NC 28314-4461 | 2009-04-21 |
| 1194932673 | Thomas Harrison Gentry IIi | Military Health Care Provider | 110 Fieldcrest Dr, Jacksonville, NC 28546-9673 | 2007-05-16 |
| 1528044872 | Tina M Starling | Military Health Care Provider | U.S. Coast Guard, Support Center Medical, Elizabeth City, NC 27909 | 2005-12-19 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.