STACEY M. SMITH (NPI# 1972743185) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972743185 |
| Entity Type | Individual |
| Full Name | STACEY M. SMITH |
| Other Name | STACEY RENEE MOOSE |
| Credential | PA |
| Practice Address |
2010 Baldwin Ln Winston Salem NC 27103-5846 |
| Mailing Address |
Po Box 751803 Charlotte NC 28275-1803 |
| Practice Telephone | 3362771717 |
| Mailing Telephone | 3362771717 |
| Enumeration Date | 2009-02-27 |
| Last Update Date | 2020-10-28 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | 103070 | NC | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363AM0700X |
Physician Assistant Specialization: Medical |
0110003000 | VA | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790385771 | Stacey Smith | Physical Therapy Assistant | 24 Deer Run Rd, Little Egg Harbor Twp, NJ 08087-9722 | 2020-10-28 |
| 1205487139 | Stacey C Smith | Case Manager/Care Coordinator | 4166 Lindell Blvd Ste 1b, Saint Louis, MO 63108-2923 | 2019-09-23 |
| 1356812994 | Stacey Smith | Doula | 8711 Whitson Ct, Springfield, VA 22153-1268 | 2018-12-07 |
| 1871000745 | Stacey Smith | Counselor | 8622 Winton Rd Ste A, Cincinnati, OH 45231-4823 | 2018-01-02 |
| 1992150411 | Stacey Smith | Community Health Worker | 3042 Fitzgerald St, Jacksonville, FL 32254-3947 | 2016-05-03 |
| 1942664669 | Stacey Smith | Pharmacist | 124845 Main St, Williston, SC 29853-2711 | 2016-04-08 |
| 1184085813 | Stacey Smith | Psychologist | 2211 S Mill Ave, Tempe, AZ 85282-2115 | 2016-03-08 |
| 1881011716 | Stacey Amanda Smith | Pharmacist | 4468 Eagle River Run, Broomfield, CO 80023-8753 | 2014-03-28 |
| 1164755765 | Stacey V Smith | Counselor | 69 Mascot St, Dorchester Center, MA 02124-4130 | 2009-09-14 |
| 1831357185 | Stacey Marie Smith | Specialist/Technologist, Other | 1816 N 155th St, Shoreline, WA 98133-6014 | 2008-05-22 |
| Street Address |
2010 BALDWIN LN |
| City | WINSTON SALEM |
| State | NC |
| Zip Code | 27103-5846 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477540466 | John J Smith IIi | Urology | 2010 Baldwin Ln, Winston Salem, NC 27103-5846 | 2005-10-04 |
| 1548877939 | Sarah Katherine Ebersold | Urology | 2010 Baldwin Ln, Winston Salem, NC 27103-5846 | 2020-09-29 |
| 1861025348 | Rachel Day Beauchamp | Nurse Practitioner | 2010 Baldwin Ln, Winston Salem, NC 27103-5846 | 2020-02-12 |
| 1659724839 | Kevin Minwoo Chung | Physician Assistant | 2010 Baldwin Ln, Winston Salem, NC 27103-5846 | 2016-07-22 |
| 1851763361 | Melvin Nelson Levers IIi | Physician Assistant | 2010 Baldwin Ln, Winston Salem, NC 27103-5846 | 2015-10-22 |
| 1508234402 | Forsyth Memorial Hosptial Inc | Obstetrics & Gynecology | 2010 Baldwin Ln, Winston Salem, NC 27103-5846 | 2015-09-09 |
| 1174963359 | John R Laisure | Physician Assistant | 2010 Baldwin Ln, Winston Salem, NC 27103-5846 | 2013-07-02 |
| 1356632442 | Richard Heechun Shin | Urology | 2010 Baldwin Ln, Winston Salem, NC 27103-5846 | 2011-04-25 |
| 1851555858 | John Mcfarland Wilson | Urology | 2010 Baldwin Ln, Winston Salem, NC 27103-5846 | 2008-07-18 |
| 1639342835 | Brandon Lee Craven | Urology | 2010 Baldwin Ln, Winston Salem, NC 27103-5846 | 2008-04-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124648126 | Kelly Anne Wales | Pharmacist | 3917-a Westpoint Boulevard, Winston-salem, NC 27103 | 2020-04-20 |
| 1386281533 | Elena Mcginty | Nurse Practitioner | 1225 Creekshire Way, Suite 270, Winston Salem, NC 27103 | 2019-12-06 |
| 1992359442 | Madeline Pryor | Pharmacist | 255 Charlois Drive, Winston Salem, NC 27103 | 2019-08-01 |
| 1215599584 | Palmetto Oxygen LLC | Durable Medical Equipment & Medical Supplies | 1100 S Stratford Road, Building B, Suite 420, Winston Salem, NC 27103 | 2019-07-07 |
| 1548734718 | Trivy Johnson | Specialist | 1384-b Westgate Center Dr., Winston Salem, NC 27103 | 2019-01-21 |
| 1447745047 | Novant Health Rehabilitation Hospital of Winston-salem, LLC | Rehabilitation Hospital | 2475 Hillcrest Center Circle, Winston Salem, NC 27103 | 2018-06-26 |
| 1346740206 | Joseph Miller | Physical Therapist | 1605 Westbrook Dr, Suite 103, Winston-salem, NC 27103 | 2018-02-17 |
| 1548779101 | Kristin Blow | Counselor | 3000 Bethesda Pl Ste 202, Winston Salem, NC 27103 | 2017-09-27 |
| 1891213443 | Alisha Dawn Wilson | Occupational Therapy Assistant | 2101 Homestead Hills Drive, Winston Salem, NC 27103 | 2017-09-05 |
| 1588186969 | Brandy Wilson | Social Worker | 153 Cameron Way Circle, Winston Salem, NC 27103 | 2017-07-07 |
| Find all providers in zip 27103 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598375032 | Anthony Gentile | Physician Assistant | 2632 Wynbrook Dr, Winston Salem, NC 27103-8005 | 2020-08-07 |
| 1376152074 | Meera Shah | Physician Assistant | 3288 Robinhood Rd Ste 202, Winston Salem, NC 27106-5464 | 2020-07-28 |
| 1770118457 | Heather Leigh Bissell | Physician Assistant | 153 Lavender Ln, Winston Salem, NC 27107-6023 | 2020-03-03 |
| 1245899806 | Cheryl L Sizer | Physician Assistant | Wake Forest Baptist Health 1 Medical Center Blvd, Winston Salem, NC 27157-0001 | 2019-06-07 |
| 1235606575 | Vincent James Alderete | Physician Assistant | Wake Forest Baptist Health 1 Medical Center Boulevard, Winston Salem, NC 27157-0001 | 2018-10-25 |
| 1386127538 | Frederick Keith Stirewalt | Physician Assistant | Medical Center Blvd Faithhealth, Winston Salem, NC 27157-0001 | 2018-09-13 |
| 1164936852 | Lindsay Webster | Physician Assistant | 10479 Nc-109, 107a, Winston Salem, NC 27107 | 2017-11-17 |
| 1518477694 | Raul Canchari Ames | Physician Assistant | 512 Waughtown St, Winston Salem, NC 27127-2236 | 2017-10-03 |
| 1922528611 | Devon Adams | Physician Assistant | 1 Medical Center Blvd Gastroenterology Dept, Winston Salem, NC 27157-7223 | 2017-06-22 |
| 1053862474 | Seguin Warwick Beuerlein | Physician Assistant | 2425 Riley Forest Dr, Winston Salem, NC 27127-7573 | 2016-10-20 |
| Find all providers in WINSTON SALEM | ||||
| City | WINSTON SALEM |
| Zip Code | 27103 |
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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.