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

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