Provider Demographics
NPI:1316264609
Name:STAGER, ANGEL M
Entity type:Individual
Prefix:MISS
First Name:ANGEL
Middle Name:M
Last Name:STAGER
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ANGEL
Other - Middle Name:M
Other - Last Name:ABNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3840 TROUT CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-5300
Mailing Address - Country:US
Mailing Address - Phone:859-533-5280
Mailing Address - Fax:
Practice Address - Street 1:2335 STERLINGTON RD STE 100
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-3937
Practice Address - Country:US
Practice Address - Phone:859-912-7670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-26
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY171M00000X
KY282119101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1790731081Medicaid