=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336025808
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STACY JO FERRIS CDCES
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2025
-----------------------------------------------------
Last Update Date | 08/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3410 FUTURES DR
-----------------------------------------------------
City | SOUTH SIOUX CITY
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68776-3917
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 402-412-7242
-----------------------------------------------------
Fax | 712-252-2744
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4537 MANOR CIR
-----------------------------------------------------
City | SIOUX CITY
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 51104-1046
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 712-574-1480
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WD0400X
-----------------------------------------------------
Taxonomy Name | Diabetes Educator Registered Nurse
-----------------------------------------------------
License Number | 32300544
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------