Provider Demographics
NPI:1851549422
Name:STAPLES, STACIA ASHLEY (ARNP)
Entity Type:Individual
Prefix:
First Name:STACIA
Middle Name:ASHLEY
Last Name:STAPLES
Suffix:
Gender:F
Credentials:ARNP
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 66
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:KY
Mailing Address - Zip Code:42206-0066
Mailing Address - Country:US
Mailing Address - Phone:270-542-8888
Mailing Address - Fax:270-542-7335
Practice Address - Street 1:104 E MAIN ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:KY
Practice Address - Zip Code:42206-5106
Practice Address - Country:US
Practice Address - Phone:270-542-8888
Practice Address - Fax:270-542-7335
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5699P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100057170Medicaid
0653603Medicare PIN