MEDICARE: MRS. MARTIZA CHANTAY STALLINS APRN

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	363LF0000X	Family Nurse Practitioner	3002951	KY

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

General Provider Information

NPI Number	:	1184721714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARTIZA CHANTAY STALLINS APRN

Provider Business Mailing Address
First Line	:	PO BOX 9150
Second Line	:
City	:	PADUCAH
State	:	KY
Zip	:	42002-9150
Country	:	US
Telephone Number	:	270-744-9600
Fax Number	:	270-744-8642

Provider Business Practice Location Address
First Line	:	605 S JEFFERSON ST
Second Line	:
City	:	PRINCETON
State	:	KY
Zip	:	42445-2173
Country	:	US
Telephone Number	:	270-365-9455
Fax Number	:	270-365-9456

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

Provider Enumeration Date	:	09/17/2006
Last Update Date	:	10/26/2016

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