Healthcare Provider Details

I. General information

NPI: 1629855085
Provider Name (Legal Business Name): MARIANNE KATHRYN STAGGS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 S MAIN CROSS ST
LOUISA KY
41230-1065
US

IV. Provider business mailing address

125 S MAIN CROSS ST
LOUISA KY
41230-1330
US

V. Phone/Fax

Practice location:
  • Phone: 606-638-0938
  • Fax:
Mailing address:
  • Phone: 606-638-0938
  • Fax: 859-813-5394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4008892
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: