Provider Demographics
NPI:1174514657
Name:STAUDENMEIER, JAMES JOSEPH (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:JOSEPH
Last Name:STAUDENMEIER
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2038 MOSSY OAK CIR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-5949
Mailing Address - Country:US
Mailing Address - Phone:315-523-4253
Mailing Address - Fax:
Practice Address - Street 1:243 DOVER RD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-4155
Practice Address - Country:US
Practice Address - Phone:931-905-4646
Practice Address - Fax:833-278-1934
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2018-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY467022084P0800X, 2084P0802X, 2084P0804X
MO20130228902084P0802X, 2084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ037630Medicaid
AR210425001Medicaid
MO1174514657Medicaid
KY7100344430Medicaid