Provider Demographics
NPI:1629534979
Name:STAGGS, BROOKE DAVIS (DMPNA, APRN-CRNA)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:DAVIS
Last Name:STAGGS
Suffix:
Gender:F
Credentials:DMPNA, APRN-CRNA
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:RENEE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMPNA, APRN-CRNA
Mailing Address - Street 1:6900 MERRICK CREEK RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25702-9754
Mailing Address - Country:US
Mailing Address - Phone:304-541-6851
Mailing Address - Fax:
Practice Address - Street 1:2900 1ST AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25702-1241
Practice Address - Country:US
Practice Address - Phone:304-526-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-12
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV88938163W00000X
WV103757367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse