Individual
AMANDA STAGG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
828 LANE ALLEN RD STE 219, LEXINGTON, KY 40504-3659
(260) 483-9081
Mailing address
5221 OAK GROVE RD, EVANSVILLE, IN 47715-2342
(620) 566-5392
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28236174A
IN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
4015968
KY
Other
Enumeration date
12/04/2023
Last updated
02/28/2024
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