Provider Demographics
NPI:1467446567
Name:STAGGS, MICHELLE D (ANP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:D
Last Name:STAGGS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4416 FRANK ELLIS RD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72210-4804
Mailing Address - Country:US
Mailing Address - Phone:501-681-7951
Mailing Address - Fax:
Practice Address - Street 1:11321 INTERSTATE 30
Practice Address - Street 2:SUITE 306
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209-7040
Practice Address - Country:US
Practice Address - Phone:501-407-0200
Practice Address - Fax:501-407-0220
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01749363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARQ12977Medicare UPIN
AR5X829Medicare PIN