JACK ALLAN STAUFFER FNP NPI 1396703740

NPI Information

  • NPI: 1396703740
  • Provider Name: JACK ALLAN STAUFFER, FNP
  • Classification: Nurse Practitioner - 363LF0000X
  • Specialization: Family
  • Entity Type: Individual
  • Address: 435 N CEDAR ST
    SUMMERVILLE, SC
    ZIP 29483
  • Phone: (843) 873-1592

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NPI Details

Jack Allan Stauffer, FNP is a family nurse practitioner in Summerville, SC. Jack Allan Stauffer, FNP NPI is 1396703740. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

435 N CEDAR ST
SUMMERVILLE, SC
ZIP 29483-407
Phone: (843) 873-1592
Fax: (843) 820-3373

The enumeration date for this NPI number is 5/3/2006 and was last updated on 8/30/2016.

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
1363LF0000XNurse PractitionerFamily629SOUTH CAROLINAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1SC46486868MEDICARE PINSOUTH CAROLINA
2SC46487819MEDICARE PINSOUTH CAROLINA
3SC46486882MEDICARE PINSOUTH CAROLINA
4SC46485282MEDICARE PINSOUTH CAROLINA
5P00851396OTHERSOUTH CAROLINARR MEDICARE PTAN
6SC46487499MEDICARE PINSOUTH CAROLINA
7Q319037522MEDICARE PINSOUTH CAROLINA
8SC46488798MEDICARE PINSOUTH CAROLINA
9SC46487006MEDICARE PINSOUTH CAROLINA
10Q31903MEDICARE UPINSOUTH CAROLINA
11SC46486834MEDICARE PINSOUTH CAROLINA
12SC46487498MEDICARE PINSOUTH CAROLINA
13SC46487555MEDICARE PINSOUTH CAROLINA
14SC46485281MEDICARE PINSOUTH CAROLINA
15SC46485277MEDICARE PINSOUTH CAROLINA
16NP0021MEDICAIDSOUTH CAROLINA
17SC46487126MEDICARE PINSOUTH CAROLINA

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: 11/21/2025

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