Provider Demographics
NPI:1962867713
Name:STAPLES HEALTH CLINIC, LLC
Entity type:Organization
Organization Name:STAPLES HEALTH CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACIA
Authorized Official - Middle Name:
Authorized Official - Last Name:STAPLES
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:270-438-3474
Mailing Address - Street 1:PO BOX 66
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:KY
Mailing Address - Zip Code:42206-0066
Mailing Address - Country:US
Mailing Address - Phone:270-438-3474
Mailing Address - Fax:
Practice Address - Street 1:104 E MAIN ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:KY
Practice Address - Zip Code:42206-5106
Practice Address - Country:US
Practice Address - Phone:270-438-3474
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-21
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3005699363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty