Provider Demographics
NPI:1346986940
Name:STAGGS, JACQUELINE DIANE
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:DIANE
Last Name:STAGGS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3028 THREE WAY RD
Mailing Address - Street 2:
Mailing Address - City:DECATURVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38329-4284
Mailing Address - Country:US
Mailing Address - Phone:731-852-2574
Mailing Address - Fax:
Practice Address - Street 1:3028 THREE WAY RD
Practice Address - Street 2:
Practice Address - City:DECATURVILLE
Practice Address - State:TN
Practice Address - Zip Code:38329-4284
Practice Address - Country:US
Practice Address - Phone:731-852-2574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-07
Last Update Date:2022-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide