Stackhouse, James Timothy

Stackhouse, James Timothy is an individual health care provider with primary practice located at Us Hwy 491 North , Shiprock NM 87420. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as his primary health care specialty. Stackhouse, James Timothy can be contacted via phone (505) 368-6401.

Contact Information

Primary practice address
Us Hwy 491 North Shiprock NM 87420
Phone: (505) 368-6401
Fax: (505) 368-6431
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 03435481 New York
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X CRNA0631 Arizona
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X R49230NM Arizona
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X CRNA00781 New Mexico

Profile Details

NPI number 1730177494
LBN Legal business name Stackhouse, James Timothy
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 7th, 2005
Last updated Jan 25th, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1730177494 NPPES
Arizona MEDICAID 697766
Arizona MEDICAID 79836534
Arizona MEDICAID R5071

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