Provider Demographics
NPI:1730669086
Name:STAGGS, TYLON (RN)
Entity type:Individual
Prefix:
First Name:TYLON
Middle Name:
Last Name:STAGGS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TYLON
Other - Middle Name:
Other - Last Name:BOGGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1034 GLENDALE AVE # A
Mailing Address - Street 2:
Mailing Address - City:WHEELERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45694-9381
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1034 GLENDALE AVE # A
Practice Address - Street 2:
Practice Address - City:WHEELERSBURG
Practice Address - State:OH
Practice Address - Zip Code:45694-9381
Practice Address - Country:US
Practice Address - Phone:730-307-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV119926363LP0808X
OHAPRN.CNP.0036302363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health