Basic Information
| Provider Information | |||||||||
| NPI: | 1073781407 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STAGG | ||||||||
| FirstName: | ANNETTE | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.S.N., A.R.N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 480 S ROGERS RD | ||||||||
| Address2: | |||||||||
| City: | OLATHE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660621706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9133243642 | ||||||||
| FaxNumber: | 9137803387 | ||||||||
| Practice Location | |||||||||
| Address1: | 480 S ROGERS RD | ||||||||
| Address2: | |||||||||
| City: | OLATHE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660621706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9133243642 | ||||||||
| FaxNumber: | 9137803387 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/19/2008 | ||||||||
| LastUpdateDate: | 08/15/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SP0808X | 74284 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 11474144 | 01 | KS | CAQH | OTHER | 100423870 | 01 | KS | KMAP | OTHER |