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General NPI Number Information
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NPI Number | 1750743746
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Entity Type | Individual
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Provider Name | CARLETTA STACKHOUSE MS, AGPCNP-BS
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Gender | Female
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Dates
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Enumeration Date | 03/28/2016
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Last Update Date | 06/29/2026
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Provider Practice Location Address
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Address Line | 275 BROADWAY
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City | LYNBROOK
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State | NY
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Zip | 11563-3243
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Country | US
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Telephone | 516-515-0597
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Fax | 516-837-9847
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Provider Business Mailing Address
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Address Line | PO BOX 328
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City | MALVERNE
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State | NY
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Zip | 11565-0328
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Country | US
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Telephone | 516-253-0035
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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 | 163WH0200X
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Taxonomy Name | Home Health Registered Nurse
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License Number | 524609
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 307783
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License Number State | NY
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