Healthcare Provider Details

I. General information

NPI: 1326953274
Provider Name (Legal Business Name): ANGELA MARIE STAYTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9269 THOMASON TRL
ANTIOCH TN
37013-3981
US

IV. Provider business mailing address

9269 THOMASON TRL
ANTIOCH TN
37013-3981
US

V. Phone/Fax

Practice location:
  • Phone: 615-870-2761
  • Fax:
Mailing address:
  • Phone: 615-870-2761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number42718
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: