Healthcare Provider Details

I. General information

NPI: 1174809727
Provider Name (Legal Business Name): BEVERLY JOAN STAGGS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2011
Last Update Date: 01/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 N MOUNT JULIET RD
MOUNT JULIET TN
37122-8015
US

IV. Provider business mailing address

317 BOWWOOD DR
NASHVILLE TN
37217-2301
US

V. Phone/Fax

Practice location:
  • Phone: 615-758-4100
  • Fax: 615-758-5450
Mailing address:
  • Phone: 615-294-9639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number9616
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number1019
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: