Individual
JEREMY RYAN STAPLETON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3100 MACCORKLE AVE SE STE 500, CHARLESTON, WV 25304-1226
(304) 342-0821
(304) 345-6679
Mailing address
3100 MACCORKLE AVE SE STE 500, CHARLESTON, WV 25304-1226
(304) 342-0821
(304) 345-6679
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
03019
KY
207RG0100X
Gastroenterology Physician
Primary
2126
WV
208M00000X
Hospitalist Physician
03019
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000628054
ANTHEM - NIS
KY
01
—
000028412U
HUMANA - NIS
KY
01
—
107365
SIHO - NIS
KY
05
—
200963400
—
IN
01
—
2546966
CIGNA - NIS
KY
01
—
3733152000
PASSPORT ADVANTAGE - NIS
KY
05
—
3810019300
—
WV
01
—
50025382
PASSPORT - NIS
KY
05
—
7100080660
—
KY
Enumeration date
03/05/2007
Last updated
09/30/2025
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