Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Derick Stackpole

Individual provider Physician Assistant · NPI 1396217485

Derick Stackpole is a Physician Assistant in Roanoke, Virginia. Qualified in 2018, 8 years ago. Practices with Carilion Emergency Services Inc, a 69-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Virginia.

Years since qualifying
8
Licensed in
VA
In the registry since
2018
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Practice location Address checks out

4035 Electric Rd Ste A
Roanoke, VA 24018
Phone: (540) 772-8670
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1906 Belleview Ave Se, Roanoke, VA 24014-1838 — (540) 314-9194

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 0110006532 (VA)

Record details

NPI number1396217485
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedDecember 30, 2018
Last updated in NPPESAugust 29, 2019
Mailing address4035 Electric Rd Ste A, Roanoke, VA 24018-8449

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Group practice Carilion Emergency Services Inc — 69 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations6 on file with Medicare

Other providers in Roanoke