STACY JO KENNEDY (NPI# 1669947610) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1669947610 |
| Entity Type | Individual |
| Full Name | STACY JO KENNEDY |
| Credential | FNP- BC |
| Practice Address |
191 Overthrust Rd Evanston WY 82930-9261 |
| Mailing Address |
249 Douglas Dr Rock Springs WY 82901-3148 |
| Practice Telephone | 3077898721 |
| Mailing Telephone | 3073711601 |
| Enumeration Date | 2018-10-05 |
| Last Update Date | 2019-06-24 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
30260.1816 | WY | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1441 Wilkins Cir, Casper, WY 826011337 | 3072332700 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235149931 | Stacy Kennedy | Dietitian, Registered | 1404 Commonwealth Ave, #4, Brighton, MA 02135-3722 | 2006-08-08 |
| 1720052616 | Stacy Ann Kennedy | Nurse Practitioner | 3 Medical Plz, Mountain Home, AR 72653-2918 | 2006-02-15 |
| 1144869967 | Stacy Kennedy | Pharmacist | 808 N 12th St, Murray, KY 42071-1666 | 2019-12-26 |
| 1699278127 | Stacy Kennedy | Occupational Therapist | 1447 N Harrison St, Saginaw, MI 48602-4727 | 2018-03-12 |
| 1063556496 | Stacy D. Kennedy | Internal Medicine | 611 Mocksville Ave., Salisbury, NC 28144-2705 | 2007-02-18 |
| 1720149016 | Stacy Kennedy | Optometrist | 1801 Manhattan Blvd, U, Harvey, LA 70058-7300 | 2006-12-12 |
| Street Address |
191 OVERTHRUST RD |
| City | EVANSTON |
| State | WY |
| Zip Code | 82930-9261 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407832728 | Jason P Haack | Otolaryngology | 191 Overthrust Rd, Evanston, WY 82930-9261 | 2005-12-19 |
| 1194226266 | High Desert Psychology and Wellness | Clinic/Center | 191 Overthrust Rd, Evanston, WY 82930-9261 | 2018-02-23 |
| 1790172807 | Uinta Health Lab, LLC | Clinical Medical Laboratory | 191 Overthrust Rd, Evanston, WY 82930-9261 | 2015-04-16 |
| 1023404514 | Utah Podiatry Group PC | Podiatrist | 191 Overthrust Rd, Evanston, WY 82930-9261 | 2015-04-10 |
| 1962804443 | Barker Family Health, LLC | Nurse Practitioner | 191 Overthrust Rd, Evanston, WY 82930-9261 | 2014-09-16 |
| 1790067999 | Corrie Carver | Nurse Practitioner | 191 Overthrust Rd, Evanston, WY 82930-9261 | 2011-09-13 |
| 1730335423 | Southwest Wyoming Ent Inc | Otolaryngology | 191 Overthrust Rd, Evanston, WY 82930-9261 | 2008-08-13 |
| 1255476131 | Adam K Fuller | Psychologist | 191 Overthrust Rd, Evanston, WY 82930-9261 | 2007-02-20 |
| 1144328949 | Jared Breck Barton | Surgery | 191 Overthrust Rd, Evanston, WY 82930-9261 | 2006-09-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598398935 | Colby Kim Gomez | Physical Therapist | 190 Arrowhead Dr, Evanston, Wy 82930, Evanston, WY 82930 | 2020-02-13 |
| 1164808382 | Marilyn Carol Edgeworth Tacoma | Registered Nurse | 1037 Morse Lee St, Evanston, WY 82930 | 2015-08-11 |
| 1699159723 | Impact Physical Therapy LLC | Clinic/Center | 96 Yellow Creek Road, Evanston, WY 82930 | 2015-07-18 |
| 1578942421 | Mark Carstensen | Case Manager/Care Coordinator | 219 7th Street, Evanston, WY 82930 | 2015-05-26 |
| 1013396241 | Jennifer Carstensen | Case Manager/Care Coordinator | 325 Arrowhead Drive, Evanston, WY 82930 | 2015-05-20 |
| 1780083782 | Christa Lena Barker | Nurse Practitioner | 191 Overthrust Road, Evanston, WY 82930 | 2014-08-15 |
| 1366865339 | Don Mckay Francom | Dentist | 170 Arrowhead Dr. Suite 1, Evanston, WY 82930 | 2014-01-28 |
| 1417228370 | Premier Surgical Center, LLC | Clinic/Center | 195 Overthrust Road, Evanston, WY 82930 | 2012-01-24 |
| 1588959324 | Mejia D Williams | Social Worker | 190 Overthrust Road, Evanston, WY 82930 | 2011-06-09 |
| 1225327000 | Richard Jay Capener | Family Medicine | 196 Arrowhead Dr Ste 1, Evanston, WY 82930 | 2011-04-01 |
| Find all providers in zip 82930 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871103291 | Mary Driscoll | Nurse Practitioner | 800 Austin St Ste 207, Evanston, IL 60202-3442 | 2020-08-01 |
| 1013566892 | Reba Elizabeth Mathew | Nurse Practitioner | 500 Asbury Ave # 316-3320, Evanston, IL 60202-2724 | 2019-09-05 |
| 1952768210 | Jacqueline Christie | Nurse Practitioner | 215d Dodge Ave, Evanston, IL 60202-3669 | 2016-01-18 |
| 1962873075 | Laura E Hilb | Nurse Practitioner | 2121 Dewey Ave, Evanston, IL 60201-3057 | 2015-10-14 |
| 1871982876 | Mirela Shuleva | Nurse Practitioner | 2221 Central St Apt 3e, Evanston, IL 60201-5750 | 2015-01-13 |
| 1780083782 | Christa Lena Barker | Nurse Practitioner | 191 Overthrust Road, Evanston, WY 82930 | 2014-08-15 |
| 1720303993 | Olatokunbo Olorunfemi | Nurse Practitioner | 3333 Central Street, Evanston, IL 60201-1150 | 2010-03-31 |
| 1598868689 | Mary Elizabeth Coffeen-carley | Nurse Practitioner | 831 St. Highway, 150 South, Wyoming State Hospital, Evanston, WY 82931 | 2006-09-06 |
| 1982614723 | Kimberly S Larson | Nurse Practitioner | 170 Arrowhead Dr, Evanston, WY 82930-9266 | 2006-08-08 |
| 1013916519 | Evanston Clinic Corp | Nurse Practitioner | 196 Arrowhead Dr Ste 8, Evanston, WY 82930-8752 | 2005-07-18 |
| Find all providers in EVANSTON | ||||
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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.