Healthcare Provider Details

I. General information

NPI: 1457601551
Provider Name (Legal Business Name): ANN STAGGS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANN KIESEL

II. Dates (important events)

Enumeration Date: 09/16/2012
Last Update Date: 03/18/2021
Certification Date: 03/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 WILLOW ST
VINCENNES IN
47591-1028
US

IV. Provider business mailing address

1160 E SAINT CLAIR ST
VINCENNES IN
47591-4853
US

V. Phone/Fax

Practice location:
  • Phone: 812-882-5220
  • Fax:
Mailing address:
  • Phone: 812-885-3106
  • Fax: 812-885-8499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28144315A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71004134A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71004134A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: