Individual provider Active NPI

Marianne Kathryn Staggs

  • Psychiatric/Mental Health Nurse Practitioner
  • Louisville, KY
National Provider Identifier
1629855085
Registry record updated Mar 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
4008892 Issued in KY
Practice address
1930 Wrocklage Ave
Louisville, KY 40205-2150
Phone
(270) 535-3228
NPI assigned
Sep 11, 2023
Last updated
Mar 24, 2026By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 24, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 4008892 KY Primary

Addresses

Primary practice location

1930 Wrocklage Ave
Louisville, KY 40205-2150

Mailing address

125 S Main Cross St
Louisa, KY 41230-1330
Phone (606) 638-0938

Other practice location 1

125 S Main Cross St
Louisa, KY 41230-1065
Phone (606) 638-0938

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260401000709 KY Practitioner - Nurse Practitioner 9133604721 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2023
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

66 E Flagler St
Miami, FL 33130-1807

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4008892KYMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Pioneer Health Group LLC PastSince Aug 11, 2026 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1694390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774310400000",
    "number": "1629855085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 S MAIN CROSS ST",
            "city": "LOUISA",
            "state": "KY",
            "postal_code": "412301330",
            "telephone_number": "606-638-0938",
            "fax_number": "859-813-5394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1930 WROCKLAGE AVE",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402052150",
            "telephone_number": "270-535-3228"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "125 S Main Cross St",
            "address_purpose": "LOCATION",
            "city": "Louisa",
            "state": "KY",
            "postal_code": "412301065",
            "country_code": "US",
            "telephone_number": "606-638-0938",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STAGGS",
        "first_name": "MARIANNE",
        "middle_name": "KATHRYN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-09-11",
        "last_updated": "2026-03-24",
        "certification_date": "2026-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "KY",
            "license": "4008892",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.