Provider Demographics
NPI:1578178679
Name:STIGALL, AMELIA KATE (PA-C)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:KATE
Last Name:STIGALL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AMELIA
Other - Middle Name:KATE
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8011 CLAYTON RD STE 216
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1156
Mailing Address - Country:US
Mailing Address - Phone:618-521-1869
Mailing Address - Fax:
Practice Address - Street 1:1301 E DEYOUNG ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-3846
Practice Address - Country:US
Practice Address - Phone:618-997-1365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-15
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL85007601363AM0700X
IL085007601363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical