Healthcare Provider Details

I. General information

NPI: 1194371344
Provider Name (Legal Business Name): STACY WINTERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2019
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5246 CHAMBERLAYNE RD
RICHMOND VA
23227-2950
US

IV. Provider business mailing address

PO BOX 746871
ATLANTA GA
30374-6871
US

V. Phone/Fax

Practice location:
  • Phone: 804-913-7029
  • Fax:
Mailing address:
  • Phone: 773-352-1515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024187037
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR201184
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: