Provider Demographics
NPI:1336025808
Name:FERRIS, STACY JO (CDCES)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:JO
Last Name:FERRIS
Suffix:
Gender:F
Credentials:CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4537 MANOR CIR
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-1046
Mailing Address - Country:US
Mailing Address - Phone:712-574-1480
Mailing Address - Fax:
Practice Address - Street 1:3410 FUTURES DR
Practice Address - Street 2:
Practice Address - City:SOUTH SIOUX CITY
Practice Address - State:NE
Practice Address - Zip Code:68776-3917
Practice Address - Country:US
Practice Address - Phone:402-412-7242
Practice Address - Fax:712-252-2744
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA32300544163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator