Stacey Waddington, PA-C
Physician Assistant in Shelbyville, IL. Individual provider (NPI-1).
NPI number1154578615
StatusActive
Last updated in NPPESFeb 2, 2022
Details
- NPI
- 1154578615
- Entity type
- Individual (NPI-1)
- Name
- Stacey Waddington
- Credential
- PA-C
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Aug 26, 2008
- Certification date
- Feb 2, 2022
- Last updated
- Feb 2, 2022
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - PHYSICIAN ASSISTANT
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility Yes · Hospice No
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | 085-003283 | IL | Yes |
Practice location
200 S Cedar StShelbyville, IL 62565-1838
Phone 217-774-4400 · Fax 217-774-6445
Mailing address
1025 S 6th StSpringfield, IL 62703-2403
Phone 217-528-7541
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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