STACEY STOKES ROUSSELL MD NPI 1770629099

NPI Information

  • NPI: 1770629099
  • Provider Name: STACEY STOKES ROUSSELL, MD
  • Classification: Pediatrics - 208000000X
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 439 COUNTRY LN
    LOUISVILLE, KY
    ZIP 40207
  • Phone: (502) 939-5378

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NPI Details

Stacey Stokes Roussell, MD is a pediatrics in Louisville, KY. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. Stacey Stokes Roussell, MD NPI is 1770629099. 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:

439 COUNTRY LN
LOUISVILLE, KY
ZIP 40207-803
Phone: (502) 939-5378

The NPI 1770629099 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 1/30/2007 and was last updated on 5/8/2024.

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
12080A0000XPediatricsAdolescent Medicine35005KENTUCKYNo
2208000000XPediatrics35005KENTUCKYYes

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
1000000200556OTHERKENTUCKYANTHEM
264035678MEDICAIDKENTUCKY
3000000200556OTHERKENTUCKYPASSPORT HEALTH PLAN
450035679OTHERKENTUCKYPASSPORT - KCMA
5000000739400OTHERKENTUCKYANTHEM - KCMA
6129357OTHERKENTUCKYSIHO - KCMA
7611356201OTHERKENTUCKYTAX ID

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: 3/30/2025

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