Provider Demographics
NPI:1356599823
Name:BENEFIELD, STACEY HINKLE (AUD)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:HINKLE
Last Name:BENEFIELD
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:ELIZABETH
Other - Last Name:HINKLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6035 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3256
Mailing Address - Country:US
Mailing Address - Phone:704-295-3000
Mailing Address - Fax:704-838-8494
Practice Address - Street 1:6035 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3256
Practice Address - Country:US
Practice Address - Phone:704-295-3000
Practice Address - Fax:704-838-8494
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8222231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7413273Medicaid
NCP01044535OtherRAILROAD MEDICARE PTAN
SC30109275OtherSELECT HEALTH
SC104156OtherWELLCARE OF SC
SC772375OtherWELLCARE
SCSAN092Medicaid
6536546OtherCIGNA
NC1618JOtherBCBSNC
SCSAN092Medicaid
NC7413273Medicaid