1760012512 NPI number — ANGELIQUE MELLO STAGGS LMT, NBCMTB

Table of content: ANGELIQUE MELLO STAGGS LMT, NBCMTB (NPI 1760012512)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760012512 NPI number — ANGELIQUE MELLO STAGGS LMT, NBCMTB

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STAGGS
Provider First Name:
ANGELIQUE
Provider Middle Name:
MELLO
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMT, NBCMTB
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760012512
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4903 HALSEY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHAWNEE
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66216-2029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-729-5831
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10841 W 87TH ST STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OVERLAND PARK
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66214-1660
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-353-3377
Provider Business Practice Location Address Fax Number:
913-353-3401
Provider Enumeration Date:
01/21/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  2009024312 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225700000X , with the licence number: THR-065184 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1342622 . This is a "AMERICAN MASSAGE THERAPY ASSOCIATION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 597129-10 . This is a "NCBTMB" identifier . This identifiers is of the category "OTHER".
  • Identifier: THR-065184 . This is a "CITY OF OVERLAND PARK" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 2009024312 . This is a "STATE OF MISSOURI BOARD OF THERAPEUTIC MASSAGE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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