Stacy L Johnson (NPI# 1548745334, PAC ID# 0042554545) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is NURSE PRACTITIONER.
| Nation Provider ID (NPI) | 1548745334 |
| PAC ID by PECOS | 0042554545 |
| Professional Enrollment ID | I20181211001733 |
| Full Name | Stacy L Johnson |
| Organization Legal Name | INTEGRATED COMMUNITY CLINICS PA |
| Address |
1261 E Tulsa Ave Kansas OK 74347-7026 |
| Phone Number | 9188682175 |
| Gender | F |
| Graduation Year | 2018 |
| Primary Specialty | NURSE PRACTITIONER |
| Group Practice PAC ID | 2567361165 |
| Number of Group Practice Members | 27 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 040001 | SILOAM SPRINGS REGIONAL HOSPITAL |
| 370089 | NORTHEASTERN HEALTH SYSTEM |
| Address | Phone | Organization |
|---|---|---|
| 1261 E Tulsa Ave, Kansas, OK 74347-7026 | 9188682175 | INTEGRATED COMMUNITY CLINICS PA |
| 451 S Holly St, Siloam Springs, AR 72761-3018 | 4795243141 | INTEGRATED COMMUNITY CLINICS PA |
| Organization Legal Name | INTEGRATED COMMUNITY CLINICS PA |
| Physicians | 33 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Ezra L Cole | Pediatric Medicine | Integrated Community Clinics Pa | 1101 -2 N Progress Ave, Siloam Springs, AR 72761-1374 |
| Teresa B Mckinney | Physician Assistant | Integrated Community Clinics Pa | 1250 W Valley Dr, Siloam Springs, AR 72761-3018 |
| Dan J Springer | Family Medicine | Integrated Community Clinics Pa | 451 S Holly St, Siloam Springs, AR 72761-3018 |
| Ashish Mathur | Family Medicine | Integrated Community Clinics Pa | 643 E 3rd St, Gentry, AR 72734-8258 |
| Cheryl B Kroeker | Emergency Medicine | Integrated Community Clinics Pa | 108 Main Ave, Chouteau, OK 74337-2842 |
| Mark Edgar Miller | Family Medicine | Integrated Community Clinics Pa | 2630 E Citizens Dr, Suite 3, Fayetteville, AR 72703-4797 |
| Lora M Collier | Family Medicine | Integrated Community Clinics Pa | 609 E Main St, Locust Grove, OK 74352-5139 |
| Michael Davis Payne Ii | Family Medicine | Integrated Community Clinics Pa | 2630 E Citizens Dr, Suite 3, Fayetteville, AR 72703-4797 |
| Jamie L Mcdermott | Registered Dietitian Or Nutrition Professional | Integrated Community Clinics Pa | 2630 E Citizens Dr, Suite 3, Fayetteville, AR 72703-4797 |
| Jacob C Hostetler | Family Medicine | Integrated Community Clinics Pa | 1121 Neo Loop, Grove, OK 74344-6046 |
| Street Address |
1261 E TULSA AVE |
| City | KANSAS |
| State | OK |
| Zip | 74347-7026 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Daniel A Pummill | Family Medicine | Integrated Community Clinics Pa | 1261 E Tulsa Ave, Kansas, OK 74347-7026 |
| City | KANSAS |
| Zip Code | 74347 |
| Specialty | NURSE PRACTITIONER |
| City + Specialty | KANSAS + NURSE PRACTITIONER |
Please comment or provide details below to improve the information on Stacy L Johnson.
| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.