Provider Demographics
NPI:1891211496
Name:STAGNER, CHISTOPHER PAUL (CRNP)
Entity Type:Individual
Prefix:MR
First Name:CHISTOPHER
Middle Name:PAUL
Last Name:STAGNER
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 SHELTON BEACH RD APT 23
Mailing Address - Street 2:
Mailing Address - City:SARALAND
Mailing Address - State:AL
Mailing Address - Zip Code:36571-3040
Mailing Address - Country:US
Mailing Address - Phone:251-689-7145
Mailing Address - Fax:
Practice Address - Street 1:1815 HAND AVE
Practice Address - Street 2:
Practice Address - City:BAY MINETTE
Practice Address - State:AL
Practice Address - Zip Code:36507-4110
Practice Address - Country:US
Practice Address - Phone:251-937-5521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-16
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-106072363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily