MEDICARE: AMANDA LAUREN STAGGS 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	363L00000X	Nurse Practitioner	32632	TN
2	363L00000X	Nurse Practitioner	221994	AR

General Provider Information

NPI Number	:	1427772714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA LAUREN STAGGS APRN

Provider Business Mailing Address
First Line	:	18 W CAROLINA AVE APT 302
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38103-4844
Country	:	US
Telephone Number	:	901-831-5896
Fax Number	:

Provider Business Practice Location Address
First Line	:	18 W CAROLINA AVE APT 302
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38103-4844
Country	:	US
Telephone Number	:	901-831-5896
Fax Number	:

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

Provider Enumeration Date	:	09/29/2022
Last Update Date	:	09/29/2022

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