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1336025808 NPI number — STACY JO FERRIS CDCES

NPI Number: 1336025808
Health Care Provider/Practitioner: STACY JO FERRIS CDCES

Information about “1336025808” NPI (STACY JO FERRIS CDCES) exists in 1336025808 in HTML format HTML  |  1336025808 in plain Text format TXT  |  1336025808 in PDF (Portable Document Format) PDF  |  1336025808 in an XML format XML  formats.

NPI Number : 1336025808 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1336025808",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "FERRIS",
    "FirstName": "STACY",
    "MiddleName": "JO",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "CDCES",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4537 MANOR CIR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SIOUX CITY",
    "MailingAddressStateName": "IA",
    "MailingAddressPostalCode": "51104-1046",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "712-574-1480",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3410 FUTURES DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SOUTH SIOUX CITY",
    "PracticeLocationAddressStateName": "NE",
    "PracticeLocationAddressPostalCode": "68776-3917",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "402-412-7242",
    "PracticeLocationAddressFaxNumber": "712-252-2744",
    "EnumerationDate": "08/12/2025",
    "LastUpdateDate": "08/12/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "163WD0400X",
        "TaxonomyName": "Diabetes Educator Registered Nurse",
        "LicenseNumber": "32300544",
        "LicenseNumberStateCode": "IA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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