STACEY ANNE FREDERICK (NPI# 1811421068) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811421068 |
| Entity Type | Individual |
| Full Name | STACEY ANNE FREDERICK |
| Practice Address |
6601 Phoenix Ave Suite B Fort Smith AR 72903-5092 |
| Mailing Address |
1 Childrens Way Slot 512-39 Little Rock AR 72202-3500 |
| Practice Telephone | 4797859091 |
| Practice Fax Number | 4797823415 |
| Mailing Telephone | 5015268700 |
| Mailing Fax Number | 5015268740 |
| Enumeration Date | 2017-04-14 |
| Last Update Date | 2017-04-14 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 222Q00000X | Developmental Therapist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093134116 | Stacey Frederick | Licensed Practical Nurse | 4 Jefferson Plz, Poughkeepsie, NY 12601-4035 | 2014-04-16 |
| Street Address |
6601 PHOENIX AVE SUITE B |
| City | FORT SMITH |
| State | AR |
| Zip Code | 72903-5092 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245482561 | Elizabeth Janes | Developmental Therapist | 6601 Phoenix Ave, Fort Smith, AR 72903-5092 | 2008-10-17 |
| 1669845806 | Jo Batt | Developmental Therapist | 6601 Phoenix Ave, Fort Smith, AR 72903-5092 | 2015-11-10 |
| 1023485489 | Kelsey Renihan | Speech-Language Pathologist | 6601 Phoenix Ave, Fort Smith, AR 72903-5092 | 2015-09-01 |
| 1104241892 | Brenna Rainwater | Registered Nurse | 6601 Phoenix Ave, Suite B, Fort Smith, AR 72903-5092 | 2014-03-04 |
| 1649695867 | Sarah Edwards | Registered Nurse | 6601 Phoenix Ave, Fort Smith, AR 72903-5092 | 2014-02-25 |
| 1336580356 | Jessica A Sutherland | Speech-Language Pathologist | 6601 Phoenix Ave, Suite B, Fort Smith, AR 72903-5092 | 2013-07-08 |
| 1063856722 | Sandra Olivia Garrison | Licensed Practical Nurse | 6601 Phoenix Ave, Suite B, Fort Smith, AR 72903-5092 | 2013-04-24 |
| 1730446592 | Stacy Lynn Boggs | Registered Nurse | 6601 Phoenix Ave, Suite B, Fort Smith, AR 72903-5092 | 2012-04-18 |
| 1700161759 | Robin Denise Tatum | Registered Nurse | 6601 Phoenix Ave, Suite B, Fort Smith, AR 72903-5092 | 2011-10-20 |
| 1588946693 | Richard Colin Newton | Developmental Therapist | 6601 Phoenix Ave, Suite B, Fort Smith, AR 72903-5092 | 2011-09-14 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285280016 | Bhg L, LLC | Clinic/Center | 1501 Waldron Road, Ste 203, Fort Smith, AR 72903 | 2019-08-16 |
| 1457905903 | Heather Snyder | Optometrist | 1021 South Waldron Road, Fort Smith, AR 72903 | 2019-08-01 |
| 1083272223 | Pediatric Therapy Connections LLC | Clinic/Center | 7601 Westminister Pl, Fort Smith, AR 72903 | 2019-06-03 |
| 1073092821 | Baptist Health Services | Psychiatry & Neurology | 3808 Gary St Ste B, Fort Smith, AR 72903 | 2018-08-13 |
| 1104305853 | Baptist Health Services | Family Medicine | 5428 Ellsworth Rd Ste A, Fort Smith, AR 72903 | 2018-08-13 |
| 1417436171 | Baptist Health Services | Pediatrics | 5428 Ellsworth Rd Ste B, Fort Smith, AR 72903 | 2018-08-13 |
| 1558840421 | Baptist Health Services | Family Medicine | 3808 Gary St Ste A, Fort Smith, AR 72903 | 2018-08-10 |
| 1316434707 | Md Weight Loss and Wellness, LLC | Dietitian, Registered | 3416 Old Greenwood Road, Fort Smith, AR 72903 | 2018-04-20 |
| 1942695572 | Donna K Morgan | Counselor | 2408 S. 51st Court Suite G, Fort Smith, AR 72903 | 2015-03-31 |
| 1346658242 | Shelby Mural Esry | Dentist | 3200 Rogers Ave. Suite 111, Fort Smith, AR 72903 | 2014-07-24 |
| Find all providers in zip 72903 | ||||
| Taxonomy Code | 222Q00000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Developmental Therapist |
| A Developmental Therapist is a person qualified by completion of an approved program in Developmental Therapy and where applicable credentialed by the state and practicing within the scope of the credential, or credentialed by completion of education experiences as approved by the state and practicing within the scope of that credential or, where state credentialing does not exist, certified by the Board of the Developmental Therapy Association. A developmental therapist evaluates children's global development in order to identify areas of developmental delay whether arising from physiological, neurological, or environmental factors, or a combination of factors; and designs, implements, and modifies therapeutic interventions for the child and the family to promote the child's acquisition of skills in a variety of developmental areas, including cognitive processes and social interaction in order to maximize functional independence and developmental homeostasis, and improve the quality of life at home and in the community; and provides consultation for the parents and other professionals working with the family on global development. |
| Notes: Source: The Illinois Developmental Therapists Association [1/1/2007: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245482561 | Elizabeth Janes | Developmental Therapist | 6601 Phoenix Ave, Fort Smith, AR 72903-5092 | 2008-10-17 |
| 1659883593 | Lakeisha Rashelle Stinyard | Developmental Therapist | 6601 Phoenix Ave Ste B, Fort Smith, AR 72903-5092 | 2017-11-01 |
| 1689191637 | Michelle Clemens | Developmental Therapist | 6601 Phoenix Ave Ste B, Fort Smith, AR 72903-5092 | 2017-08-29 |
| 1255852463 | Amanda Renea Hickman | Developmental Therapist | 6601 Phoenix Ave Ste B, Fort Smith, AR 72903-5092 | 2017-06-28 |
| 1669845806 | Jo Batt | Developmental Therapist | 6601 Phoenix Ave, Fort Smith, AR 72903-5092 | 2015-11-10 |
| 1588946693 | Richard Colin Newton | Developmental Therapist | 6601 Phoenix Ave, Suite B, Fort Smith, AR 72903-5092 | 2011-09-14 |
| 1174775225 | Norma Jean Smith | Developmental Therapist | 6601 Phoenix Ave, Fort Smith, AR 72903-5092 | 2008-10-21 |
| 1265684575 | Karen Sue Tyler | Developmental Therapist | 6601 Phoenix Ave, Fort Smith, AR 72903-5092 | 2008-10-17 |
| 1609028901 | Cyd Angela Scoggins | Developmental Therapist | 6601 Phoenix Ave, Fort Smith, AR 72903-5092 | 2008-10-17 |
| 1548412844 | University of Arkansas for Medical Sciences | Developmental Therapist | 6601 Phoenix Ave, Fort Smith, AR 72903-5092 | 2008-10-17 |
| Find all providers in FORT SMITH | ||||
| City | FORT SMITH |
| Zip Code | 72903 |
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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.