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General NPI Number Information
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NPI Number | 1598164345
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Entity Type | Individual
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Provider Name | STACY WASHINGTON RN
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Gender | Female
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Dates
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Enumeration Date | 08/18/2014
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Last Update Date | 05/16/2024
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Provider Practice Location Address
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Address Line | 3073 BOONE TRAIL EXT
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-3805
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Country | US
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Telephone | 910-429-2263
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Fax |
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Provider Business Mailing Address
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Address Line | 2811 EAGLE CREST LN
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City | FAYETTEVILLE
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State | NC
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Zip | 28306-8093
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Country | US
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Telephone | 910-574-7882
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WM1400X
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Taxonomy Name | Nurse Massage Therapist (NMT)
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License Number | 11794
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | 222305
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License Number State | NC
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