MRS. STACIE A SIDEBOTHAM (NPI# 1710287263) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710287263 |
| Entity Type | Individual |
| Full Name | MRS. STACIE A SIDEBOTHAM |
| Credential | FNP |
| Practice Address |
405 Owen Dr Fayetteville NC 28304-3411 |
| Mailing Address |
413 Owen Dr Ste 201 Fayetteville NC 28304-3490 |
| Practice Telephone | 9103233183 |
| Practice Fax Number | 9103235488 |
| Mailing Telephone | 9103239111 |
| Mailing Fax Number | 9104842535 |
| Enumeration Date | 2010-11-01 |
| Last Update Date | 2016-04-07 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
5004935 | NC | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
405 OWEN DR |
| City | FAYETTEVILLE |
| State | NC |
| Zip Code | 28304-3411 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679576003 | Katherine Jane Griesser | Physical Therapist | 405 Owen Dr, Fayetteville, NC 28304-3411 | 2005-05-31 |
| 1659988111 | Kristina Erika Metz | Physician Assistant | 405 Owen Dr, Fayetteville, NC 28304-3411 | 2020-09-29 |
| 1003445636 | Mackenzie Jean Eikamp | Physician Assistant | 405 Owen Dr, Fayetteville, NC 28304-3411 | 2020-04-06 |
| 1437613361 | Georgina Ishak | Physician Assistant | 405 Owen Dr, Fayetteville, NC 28304-3411 | 2019-01-24 |
| 1447739149 | Rdmg Associates, Pa | Internal Medicine | 405 Owen Dr, Fayetteville, NC 28304-3411 | 2018-08-13 |
| 1235623554 | Jeffrey Thomas Riorden | Nurse Practitioner | 405 Owen Dr, Fayetteville, NC 28304 | 2018-06-20 |
| 1972803617 | Cape Fear Family Medical Care | Specialist | 405 Owen Dr, Fayetteville, NC 28304-3411 | 2010-10-28 |
| 1467779322 | James John Richard | Physician Assistant | 405 Owen Dr, Fayetteville, NC 28304 | 2010-04-30 |
| 1578791422 | Shireesha Sangineni | Family Medicine | 405 Owen Dr, Fayetteville, NC 28304 | 2009-06-30 |
| 1063689826 | Nicole Gaskins Greyshock | Internal Medicine | 405 Owen Dr, Fayetteville, NC 28304-3411 | 2008-05-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598301061 | Coast To Coast Bilingual Counseling | Social Worker | 910 Hope Mills Road, Fayetteville, NC 28304 | 2019-11-20 |
| 1811530561 | Frances L. Hurst | Technician | 6732 Carloway Dr, Fayetteville, NC 28304 | 2019-10-25 |
| 1538717764 | Rose Mary A O'conner | Technician | 3530 Madison Ave, Fayetteville, NC 28304 | 2019-08-30 |
| 1932756087 | Sally Frances Jones | Technician | 2053 Mango Circle, Fayetteville, NC 28304 | 2019-08-23 |
| 1326528803 | Jeneen Yvette Townsend | Counselor | 2671 Adams Lake Dr Apt F, Fayetteville, NC 28304 | 2018-08-15 |
| 1780179580 | Ma Cornelia Villavicencio Leano | Nurse Practitioner | 3081 Stone Carriage Cir Apt Z, Fayetteville, NC 28304 | 2018-06-25 |
| 1861986267 | Pediatric After Hours Care of Fayetteville | Pediatrics | 556 Sandhurst Drive, Fayetteville, NC 28304 | 2018-06-19 |
| 1700386133 | Good Night Medical of Ohio, LLC | Durable Medical Equipment & Medical Supplies | 405 Owen Dr Ste 202, Fayetteville, NC 28304 | 2018-02-12 |
| 1003321365 | Valleygate Dental Surgery Center of Fayetteville, LLC | Dentist | 2038 Litho Place, Fayetteville, NC 28304 | 2017-12-08 |
| 1871004663 | The Salt Project | Marriage & Family Therapist | 1611-b Owen Dr., Fayetteville, NC 28304 | 2017-10-19 |
| Find all providers in zip 28304 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528674181 | Maggie Mullican | Nurse Practitioner | 7084 S Pleasant Ridge Dr, Fayetteville, AR 72704-5447 | 2020-09-18 |
| 1720690167 | Stephen Arthur Lepak | Nurse Practitioner | 6871 Appleton Dr, Fayetteville, PA 17222-9383 | 2020-08-18 |
| 1750990255 | Towauna Daya | Nurse Practitioner | 1338 Redwine Rd, Fayetteville, GA 30215-2509 | 2020-07-30 |
| 1316555642 | Constance Ofundem Takang | Nurse Practitioner | 110 Emerald Lake Ct, Fayetteville, GA 30215-7747 | 2020-07-22 |
| 1851916472 | Breanna Mills | Nurse Practitioner | 2623 N Fire Fly Catch Dr, Fayetteville, AR 72704-6313 | 2020-06-09 |
| 1922621069 | Laura Sarai Perez | Nurse Practitioner | 480 Lees Lake Rd, Fayetteville, GA 30214-3106 | 2020-05-23 |
| 1902431125 | Crystal Baker English | Nurse Practitioner | 113 Old Bethel Rd, Fayetteville, TN 37334-6186 | 2020-03-09 |
| 1568092708 | Stephanie Elizabeth Fields | Nurse Practitioner | 1265 Highway 54 Ste 402, Fayetteville, GA 30214-4537 | 2020-01-15 |
| 1437616364 | Andrea Teal Bergman | Nurse Practitioner | Physicians Medical Walk In Care, 2893 Huntsville Hwy, Fayetteville, TN 37334-6729 | 2019-02-27 |
| 1639634447 | Arica Adams-gro'ce | Nurse Practitioner | 4028 Lifestyle Rd, Fayetteville, NC 28312-9335 | 2019-02-06 |
| Find all providers in FAYETTEVILLE | ||||
| City | FAYETTEVILLE |
| Zip Code | 28304 |
Please comment or provide details below to improve the information on MRS. STACIE A SIDEBOTHAM.
| 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.