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Active NPI 1215056718 Individual Practitioner Female Practitioner

Phyllis C Stackhouse , CRNP

Nurse Practitioner • State College, PA

Professional Overview & Biography Verified Profile Summary

Phyllis Stackhouse, CRNP is a registered healthcare professional specializing in Nurse Practitioner in State College, PA. Practice services are available at 476 ROLLING RIDGE DR under active NPI credentials.

Practice Location & Contact Primary Location

Practice Address

476 Rolling Ridge Dr
Suite 101

State College, PA 168017639

Telephone 8146894980
Fax 8146894990
Associated Practice Facility / Clinic
🏢 Synergy Massage Therapy Facility NPI 1770594509

Specialty Benchmarks & Practice Insights

Comparative analytics for Nurse Practitioner in State College, PA

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.8 Yrs
State Avg: 10.7 Yrs
Regional Practice Density
34 Specialists

Practicing in State College, PA (3955 Statewide)

Telehealth Adoption Rate
11.8% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Nurse Practitioner Primary Specialty

NUCC Taxonomy Code: 363L00000X

State License PA SP-001330-D

(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners.

Registered Nurse

NUCC Taxonomy Code: 163W00000X

State License PA RN-204012-L

(1) A registered nurse is a person qualified by graduation from an accredited nursing school (depending upon schooling, a registered nurse may receive either a diploma from a hospital program, an associate degree in nursing (A.D.N.) or a Bachelor of Science degree in nursing (B.S.N.), who is licensed or certified by the state, and is practicing within the scope of that license or certification. R.N.'s assist patient in recovering and maintaining their physical or mental health. They assist physicians during treatments and examinations and administer medications. (2) A provider who is trained and educated in a formal nursing education program at an accredited school of nursing, passes a national certification examination, and is licensed by the state to practice nursing. The individual provides nursing services to patients or clients in areas such as health promotion, disease prevention, acute and chronic care and restoration and maintenance of health across the life span.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID
103171579 (PA)

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

7 Associated Practitioners
Katy Nelson , CRNP

Nurse Practitioner - Family

NPI 1033994363

Certified Registered Nurse Practitioner

NPI 1053304931

Doctor of Osteopathic Medicine (D.O.)

Kayla Kissell , CRNP

Nurse Practitioner - Family

NPI 1083447643

Certified Registered Nurse Practitioner

Dr. Sameer Reddy , DO

Family Medicine

NPI 1396448114

Doctor of Osteopathic Medicine (D.O.)

Dr. Kristen Grine , DO

Family Medicine

NPI 1790736957

Doctor of Osteopathic Medicine (D.O.)

Susan Puglisi , CRNP

Nurse Practitioner

NPI 1821019670

Certified Registered Nurse Practitioner

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events
NPI Profile Active December 15, 2016

NPI status registered as active in NPPES database

📍
Updated Practice Location December 15, 2016

Registered at 476 ROLLING RIDGE DR, SUITE 101, STATE COLLEGE, PA 168017639 (Tel: 8146894980)

📍
Updated Business Mailing Address December 15, 2016

Registered at 476 ROLLING RIDGE DR, SUITE 101, STATE COLLEGE, PA 168017639 (Tel: 8146894980)

👤
Provider Name / Credentials Updated December 15, 2016

Recorded as PHYLLIS STACKHOUSE, CRNP

🎓
Medical Taxonomy / Specialty Registered (Primary Specialty) December 15, 2016

Registered Nurse (License #RN-204012-L in PA)

🟢
Initial NPI Registration & Enumeration March 28, 2007

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1215056718
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: March 28, 2007
Last Update: December 15, 2016
Sole Proprietor: No

Mailing Address

476 Rolling Ridge Dr, Suite 101

State College, PA 168017639

Phone: 8146894980

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.