Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mrs. Stacy Cristman Thiedeman, PA-C

Individual provider Physician Assistant · NPI 1154335800

Mrs. Stacy Cristman Thiedeman, PA-C is a Physician Assistant in Raleigh, North Carolina. Qualified in 1998, 28 years ago. Practices with Wake Specialty Physicians LLC, a 178-clinician group, accepts Medicare assignment and offers telehealth. Licensed in North Carolina.

Years since qualifying
28
Licensed in
NC
In the registry since
2006
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

23 Sunnybrook Rd Ste Number 113
Raleigh, NC 27610-1855
Phone: (919) 250-0580
Fax: (919) 250-9939
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 102584 (NC)

Record details

NPI number1154335800
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedJuly 28, 2006
Last updated in NPPESApril 13, 2021
Certification dateApril 13, 2021

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 1998 (28 years in practice)
Group practice Wake Specialty Physicians Llc — 178 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations4 on file with Medicare

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