Healthcare Provider Details

I. General information

NPI: 1346107471
Provider Name (Legal Business Name): STASHA L TUBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2026
Last Update Date: 01/26/2026
Certification Date: 01/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 SAINT FRANCIS DR
CAPE GIRARDEAU MO
63703-5049
US

IV. Provider business mailing address

173 STATE HIGHWAY C
ORAN MO
63771-8203
US

V. Phone/Fax

Practice location:
  • Phone: 573-331-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2026003649
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: