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NPI Code Detail

MEDICARE: DR. KATHERINE ISABEL STACKHOUSE CRNP

MEDICARE: DR. KATHERINE ISABEL STACKHOUSE CRNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerSP011778PA
2363LF0000XFamily Nurse Practitioner202201194NP-PPOR
3363LF0000XFamily Nurse PractitionerNP95020358CA

General Provider Information

NPI Number : 1477821510
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KATHERINE ISABEL STACKHOUSE CRNP
Provider Business Mailing Address
First Line : 333 1ST ST STE A
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94105-2661
Country : US
Telephone Number : 888-803-3370
Fax Number :
Provider Business Practice Location Address
First Line : 2418 E YORK ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19125-3006
Country : US
Telephone Number : 888-803-3370
Fax Number : 888-803-3331
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2011
Last Update Date : 06/05/2026

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