Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mr. Ilya O Stagner, FNP-C

Individual provider Nurse Practitioner · NPI 1083376750

Mr. Ilya O Stagner, FNP-C is a Nurse Practitioner in Maryville, Missouri. Qualified in 2017, 9 years ago. Practices with SSM Regional Health Services, a 166-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Kansas and Missouri.

Years since qualifying
9
Licensed in
KS, MO
In the registry since
2021
Specialties on file
2
What do these letters mean?
FNP-C — Family Nurse Practitioner, Certified
A family nurse practitioner certified by the AANP.

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Practice location Address checks out

114 E South Hills Dr
Maryville, MO 64468-2659
Phone: (660) 562-4304
Fax: (660) 562-4308
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 300 Utah St, Hiawatha, KS 66434-2314 — (785) 742-6422

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 2024009165 (MO)
Nurse Practitioner Taxonomy 363L00000X · Licence 80603 (KS)

Record details

NPI number1083376750
Entity typeIndividual (Type 1)
GenderMale
Credentials FNP-C
Sole proprietorYes
NPI enumeratedOctober 11, 2021
Last updated in NPPESApril 17, 2025
Certification dateApril 17, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2017 (9 years in practice)
Group practice Ssm Regional Health Services — 166 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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