Provider Demographics
NPI:1548751415
Name:STAGG, CAROLINE (FNP)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:STAGG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 177
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:LA
Mailing Address - Zip Code:70755-0177
Mailing Address - Country:US
Mailing Address - Phone:225-620-6830
Mailing Address - Fax:
Practice Address - Street 1:6450 LA HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:BATCHELOR
Practice Address - State:LA
Practice Address - Zip Code:70715-3212
Practice Address - Country:US
Practice Address - Phone:225-492-3775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-25
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09768363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty