MRS. STACEY ANN GOURDOUX (NPI# 1477584118) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1477584118 |
| Entity Type | Individual |
| Full Name | MRS. STACEY ANN GOURDOUX |
| Credential | ANP-C |
| Practice Address |
19841 N 27th Ave Ste 102 Phoenix AZ 85027 |
| Mailing Address |
5151 E Broadway Rd Ste 107 Mesa AZ 85206-1346 |
| Practice Telephone | 6022584951 |
| Practice Fax Number | 6234348310 |
| Mailing Telephone | 6022584951 |
| Mailing Fax Number | 4803253461 |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2018-07-09 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
AP2224 | AZ | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | 332832 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1112 E Mcdowell Rd, Phoenix, AZ 850062695 | 6022584951 | 6023401853 |
| Street Address |
19841 N 27TH AVE STE 102 |
| City | PHOENIX |
| State | AZ |
| Zip Code | 85027 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053379263 | Da-wei Liao | Internal Medicine | 19841 N 27th Ave Ste 102, Phoenix, AZ 85027 | 2006-05-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891306312 | Ashley Nicole Felipe | Registered Nurse | 25700 N 21st Ave, Phoenix, AZ 85027 | 2020-08-10 |
| 1942784376 | Crystal Rodriguez | Dentist | 2550 W Union Hills Dr Ste 201, Phoenix, AZ 85027 | 2018-09-21 |
| 1790284776 | Lydia Kuuipo Chong | Nurse Practitioner | 20414 N 27th Ave #300, Phoenix, AZ 85027 | 2018-02-06 |
| 1457867004 | Kristi Marie Mathews | Nurse Practitioner | 19829 N 29th Avenue, Phoenix, AZ 85027 | 2017-12-19 |
| 1710348362 | The Empower House, LLC | Community Based Residential Treatment Facility, Mental Illness | 18631 N. 19th Ave., Suite 158-305, Phoenix, AZ 85027 | 2016-03-10 |
| 1972979656 | Dr Daniel H Yohannes D.d.s., PC | Dentist | 602 W. Union Hills Dr, #8, Phoenix, AZ 85027 | 2015-08-17 |
| 1013346857 | Dentistry At 35th Avenu | Dentist | 18635 N 35th Avenue, Phoenix, AZ 85027 | 2013-11-02 |
| 1437592102 | Ammar Alobaidy | Psychiatry & Neurology | 21410 N 19th Ave Ste 151, Phoenix, AZ 85027 | 2013-04-12 |
| 1588900021 | Jill Elizabeth Maroscia | Social Worker | 19636 N 27th Ave #106, Phoenix, AZ 85027 | 2013-01-02 |
| 1124394515 | Sfjg Holdings LLC | Dentist | 3414 W. Union Hills Dr, Suite 12 & 14, Phoenix, AZ 85027 | 2012-03-29 |
| Find all providers in zip 85027 | ||||
| Taxonomy Code | 363LA2200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Adult Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942819230 | Care On Pllc | Nurse Practitioner | 7171 S 51 Ave, Phoenix, AZ 85339-2923 | 2020-07-23 |
| 1558985036 | Amanda Stanford | Nurse Practitioner | 925 E Mc Dowell Rd, Phoenix, AZ 85006 | 2020-06-01 |
| 1710522024 | Kelsey Conrad | Nurse Practitioner | 1 E Lexington Ave Unit 1602, Phoenix, AZ 85012-4203 | 2019-11-11 |
| 1124662408 | Rayiom Health and Wellness, Inc | Nurse Practitioner | 11225 N 28th Dr Ste A102-22, Phoenix, AZ 85029-5606 | 2019-10-30 |
| 1699259580 | Keith Dibenedetto | Nurse Practitioner | 2617 Stockton Rd, Phoenix, MD 21131-1117 | 2018-09-18 |
| 1467975698 | Samantha June Collett | Nurse Practitioner | 3201 W Peoria Ave Ste 804, Phoenix, AZ 85029 | 2017-07-19 |
| 1598135741 | Sandra Shearer | Nurse Practitioner | 513 W Lavitt Ln, Phoenix, AZ 85086-6346 | 2015-09-30 |
| 1023499860 | Kelly Lynn Schultz | Nurse Practitioner | 3944 E Hillery Dr, Phoenix, AZ 85032-5245 | 2015-06-17 |
| 1609298900 | Lorna Ann Hill | Nurse Practitioner | 13224 N 31st Pl, Phoenix, AZ 85032-6041 | 2014-01-06 |
| 1801217765 | Trifit Pain Management LLC | Nurse Practitioner | 505 E Camelback Rd, Phoenix, AZ 85012-1615 | 2013-12-19 |
| Find all providers in PHOENIX | ||||
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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.