STACEY DIANE STARK FNP
NPI 1104704477
Nurse Practitioner - Family in Poplar Bluff, MO
About Stacey Diane Stark Fnp NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
STACEY DIANE STARK FNP (NPI 1104704477) is an individual family provider in Poplar Bluff, Missouri, licensed in Missouri (2025038960) and active in the NPI registry since August 2025. She is enrolled in Medicare PECOS and is a graduate of Other (2025).
NPPES Registry Identity
Specialties & Licenses
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.
Medicare Enrollment Status
Enrolled in Medicare and accepts Medicare assignment
Stacey Diane Stark Fnp is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 63901 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
Other Providers at the Same Location NPPES 8
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
POPLAR BLUFF, MO 63901
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Stacey Stark's NPI number?
The NPI number for Stacey Stark is 1104704477. It was assigned to this individual provider in the NPPES registry on August 25, 2025.
Where is Stacey Stark located?
Stacey Stark practices at 2340 Katy Ln, Poplar Bluff, MO 63901. The listed phone number is (573) 290-3293.
What is Stacey Stark's specialty?
The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.
Is Stacey Stark enrolled in Medicare?
Yes. Stacey Stark is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.
When was this NPI record last updated?
The NPPES record for Stacey Stark was last updated on September 15, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Stacey Diane Stark, FNP · NPI 1104704477
Family physician in Poplar Bluff, Missouri. Individual provider, active in the CMS NPPES registry since August 25, 2025.
## Identity
- **NPI:** 1104704477 (Entity type: Individual)
- **Enumerated:** August 25, 2025
- **Primary specialty:** Nurse Practitioner - Family · taxonomy 363LF0000X
- **State license:** 2025038960 (Missouri)
- **Sole proprietor:** No
## Practice location
- **Address:** 2340 KATY LN, Poplar Bluff, MO 63901-2300
- **Phone:** (573) 290-3293
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Medical school:** Other, class of 2025
## Record status
- **NPPES last updated:** September 15, 2025
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Source: [NPI Profile](https://npiprofile.com/npi/1104704477) · Data from the CMS NPPES public registry.