Individual provider · Type 1 NPI

Stag B. Shadduck, PA-C

Physician Assistant · Edgewood, KY

NPI number 1962093674 Active

Practice location

560 S Loop Rd
Edgewood, KY 41017-3405

Call (859) 301-2663 Map

Fax (859) 817-7842

Specialties and licenses

TaxonomyCodeLicense
Physician Assistant Primary 363A00000XPA2904 (KY)

Physician Assistant: A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, orde…

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About NPI 1962093674

Stag B. Shadduck, PA-C's National Provider Identifier is 1962093674, issued on Jan 27, 2021. The primary taxonomy on file is Physician Assistant (363A00000X), and the practice location is in Edgewood, KY. The record was last updated on Oct 20, 2026.