Healthcare Provider Details

I. General information

NPI: 1649431495
Provider Name (Legal Business Name): STACY ELY GARRIGA RT,ND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 LAMEUSE ST
BILOXI MS
39530-3810
US

IV. Provider business mailing address

605 WARD AVE
OCEAN SPRINGS MS
39564-4846
US

V. Phone/Fax

Practice location:
  • Phone: 228-229-0512
  • Fax: 601-202-3047
Mailing address:
  • Phone: 678-988-9088
  • Fax: 601-202-3047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code2279G1100X
TaxonomyGeneral Care Registered Respiratory Therapist
License Number002608
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: