PHYLLIS C STACKHOUSE CRNP
NPI 1215056718
Nurse Practitioner in State College, PA

Active since March 28, 2007
476 ROLLING RIDGE DR, SUITE 101, STATE COLLEGE, PA 16801(814) 689-4980(814) 689-4990 Get Directions Write a Review

NPPES record last updated: December 15, 2016. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Phyllis C Stackhouse Crnp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PHYLLIS C STACKHOUSE CRNP (NPI 1215056718) is an individual nurse practitioner in State College, Pennsylvania, licensed in Pennsylvania (SP-001330-D) and active in the NPI registry since March 2007.

NPPES Registry Identity

NPI1215056718
Entity TypeIndividualFemale
Primary Taxonomy363L00000X
Provider Legal NamePHYLLIS C STACKHOUSECredential: CRNP
Location Address476 ROLLING RIDGE DR, SUITE 101State College, PA 16801-7639
Mailing Address476 Rolling Ridge Dr, Suite 101State College, PA 16801-7639 · (814) 689-4980 · Fax (814) 689-4990
Fax(814) 689-4990
Sole ProprietorNo
Enumeration DateMarch 28, 2007
Last NPPES UpdateDecember 15, 2016
NPI 1215056718 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

Primary SpecialtyNurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363L00000X
License Licensed in PA · SP-001330-D
Definition

(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.

Also ListedRegistered NurseTaxonomy 163W00000X · License RN-204012-L (PA)
476 ROLLING RIDGE DR, State College, PA 16801

Other Identifiers 1

Medicaid103171579PA

Other Providers at the Same Location NPPES 11

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Nurse Practitioner (Family)
476 ROLLING RIDGE DR
STATE COLLEGE, PA 16801
Dentist (General Practice)
476 ROLLING RIDGE DR, SUITE 110
STATE COLLEGE, PA 16801
Family Medicine
476 ROLLING RIDGE DR, SUITE 101
STATE COLLEGE, PA 16801
Orthopaedic Surgery
476 ROLLING RIDGE DR, SUITE 200
STATE COLLEGE, PA 16801
Chiropractor (Radiology)
476 ROLLING RIDGE DR
STATE COLLEGE, PA 16801
Dentist (General Practice)
476 ROLLING RIDGE DR, SUITE 110
STATE COLLEGE, PA 16801
Family Medicine
476 ROLLING RIDGE DR
STATE COLLEGE, PA 16801
Physician Assistant (Medical)
476 ROLLING RIDGE DR, SUITE 200
STATE COLLEGE, PA 16801

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 Phyllis Stackhouse's NPI number?

The NPI number for Phyllis Stackhouse is 1215056718. It was assigned to this individual provider in the NPPES registry on March 28, 2007.

Where is Phyllis Stackhouse located?

Phyllis Stackhouse practices at 476 Rolling Ridge Dr Suite 101, State College, PA 16801. The listed phone number is (814) 689-4980.

What is Phyllis Stackhouse's specialty?

The primary specialty registered for this NPI is Nurse Practitioner with taxonomy code 363L00000X.

When was this NPI record last updated?

The NPPES record for Phyllis Stackhouse was last updated on December 15, 2016. NPI Profile syncs with the weekly NPPES data releases published by CMS.