Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
STAG BLAIR SHADDUCK
Active Sole ProprietorSTAG BLAIR SHADDUCK is a Physician Assistant healthcare provider located in EDGEWOOD, Kentucky. NPI 1962093674 is currently active in the NPPES registry. Verify at CMS.
Physician Assistant · EDGEWOOD, KY
Registration Details
- NPI Number
- 1962093674
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Jan 27, 2021 (5.565094376676 yrs)
- Last Updated
- Aug 18, 2021
- License
-
TC072 (KY)
- Sole Proprietor
- Yes
Practice Information
- Address
-
560 S LOOP RDEDGEWOOD, KY, 410173405Browse KY providers · Browse ZIP 41017
- Phone
- 8593012663
- Fax
- 8598177848
- Primary Specialty
-
Physician Assistant
363A00000X
Other Physician Assistant Providers in EDGEWOOD, KY
| Name | Credential | NPI |
|---|---|---|
| DR. PAUL L LANKISCH JR. | PA C | 1750363750 |
| ANDREA C GREEN | P.A.-C | 1356328231 |
| MRS. CARMEN S. GRANDT | PA-C | 1861440984 |
| MISS CASEY LYNN DOTY | PA-C | 1053528380 |
| MRS. AMANDA MALLORY SPILLMAN | PA-C | 1881866689 |
| MRS. CORINNE LENORE MOORE | PA-C | 1225203128 |
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.