STACY WIDEMAN NPI 1386243871

NPI Information

NPI: 1386243871
Provider Name: STACY WIDEMAN
Classification: Nurse Practitioner - 363LP0808X
Entity Type: Individual

Specialization: Psychiatric/Mental Health

PECOS Registration: Yes

Address:
8450 NW 102ND AVE
DORAL, FL
ZIP 33178
Phone: (360) 643-6562
Get Directions

Stacy Wideman is a psychiatric/mental health nurse practitioner in Doral, FL. Stacy Wideman NPI is 1386243871. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

8450 NW 102ND AVE
DORAL, FL
ZIP 33178-750
Phone: (360) 643-6562

The NPI 1386243871 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 10/26/2020 and was last updated on 3/1/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health	C-RXN.0001379	COLORADO	No
2	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health	APRN61166084-NP	WASHINGTON	No
3	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health	RN225736	GEORGIA	No
4	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health	202104630NP-PP	OREGON	No
5	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health	9501782	CALIFORNIA	No
6	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health	1071418	TEXAS	No
7	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health	G168450	IOWA	No
8	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health	APRN11012260	FLORIDA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

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