Healthcare Provider Details

I. General information

NPI: 1386751709
Provider Name (Legal Business Name): JAMES MARVIN STAPLES ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 01/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 E MAIN ST
AUBURN KY
42206-5106
US

IV. Provider business mailing address

PO BOX 66
AUBURN KY
42206-0066
US

V. Phone/Fax

Practice location:
  • Phone: 270-542-8888
  • Fax: 270-542-7335
Mailing address:
  • Phone: 270-542-8888
  • Fax: 270-542-7335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3226P
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: