Provider Demographics
NPI:1881897353
Name:STAPLETON, LINDA KAY
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:KAY
Last Name:STAPLETON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:IN
Mailing Address - Zip Code:46917-9997
Mailing Address - Country:US
Mailing Address - Phone:574-686-2022
Mailing Address - Fax:574-686-2024
Practice Address - Street 1:132 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:IN
Practice Address - Zip Code:46917-9997
Practice Address - Country:US
Practice Address - Phone:574-686-2022
Practice Address - Fax:574-686-2024
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002400363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000636086OtherANTHEM
IN200915190Medicaid
IN200915190Medicaid