MEDICARE: DR. JAMES JOSEPH STAUDENMEIER M.D., MPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	46702	KY
2	2084P0802X	Addiction Psychiatry Physician	2013022890	MO
3	2084P0802X	Addiction Psychiatry Physician	46702	KY
4	2084P0804X	Child & Adolescent Psychiatry Physician	2013022890	MO
5	2084P0804X	Child & Adolescent Psychiatry Physician	46702	KY
6	2084P0800X	Psychiatry Physician	2013022890	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174514657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES JOSEPH STAUDENMEIER M.D., MPH

Provider Business Mailing Address
First Line	:	2038 MOSSY OAK CIR
Second Line	:
City	:	CLARKSVILLE
State	:	TN
Zip	:	37043-5949
Country	:	US
Telephone Number	:	315-523-4253
Fax Number	:

Provider Business Practice Location Address
First Line	:	243 DOVER RD
Second Line	:
City	:	CLARKSVILLE
State	:	TN
Zip	:	37042-4155
Country	:	US
Telephone Number	:	931-905-4646
Fax Number	:	833-278-1934

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2005
Last Update Date	:	03/05/2026

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Directions to “ DR. JAMES JOSEPH STAUDENMEIER M.D., MPH” Practice Location

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