Healthcare Provider Details

I. General information

NPI: 1477466688
Provider Name (Legal Business Name): BAY PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

828 HIGHWAY 90 STE A
BAY SAINT LOUIS MS
39520-2721
US

IV. Provider business mailing address

5663 HODA RD
KILN MS
39556-6158
US

V. Phone/Fax

Practice location:
  • Phone: 228-493-2409
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: KATHERINE STOCKSTILL
Title or Position: NURSE PRACTITIONER
Credential:
Phone: 228-493-2409