Provider Demographics
NPI:1053606145
Name:STAGGS, EMILY LINDSAY (NP)
Entity type:Individual
Prefix:MS
First Name:EMILY
Middle Name:LINDSAY
Last Name:STAGGS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7900 DALLAS ST
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-5690
Mailing Address - Country:US
Mailing Address - Phone:479-242-6647
Mailing Address - Fax:479-250-0505
Practice Address - Street 1:7900 DALLAS ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-5690
Practice Address - Country:US
Practice Address - Phone:479-242-6647
Practice Address - Fax:479-250-0505
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LATAP002568363LF0000X
ARA003988363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2169190Medicaid
LA2169190Medicaid