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

Stacey Kathryn Prudich

Individual provider Pediatric Nurse Practitioner · NPI 1831806017

Stacey Kathryn Prudich is a Pediatric Nurse Practitioner in Wake Forest, North Carolina. Licensed in North Carolina. Registered with an NPI since 2022.

Licensed in
NC
In the registry since
2022
Specialties on file
2

Practice location Address checks out

3000 Rogers Rd Ste 210
Wake Forest, NC 27587-5745
Phone: (919) 385-2120
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pediatric Nurse Practitioner (primary) Taxonomy 363LP0200X · Licence 5017148 (NC)
Pediatric Nurse Practitioner Taxonomy 363LP0200X · Licence PRUD-6TDQL (NC)

Record details

NPI number1831806017
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedOctober 28, 2022
Last updated in NPPESOctober 29, 2022
Certification dateOctober 29, 2022
Mailing address1501 Bloomingdale Dr, Cary, NC 27511-5955

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