Healthcare Provider Details

I. General information

NPI: 1174590319
Provider Name (Legal Business Name): DR. AILEAN CHASE STINGLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 07/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 W GOVERNMENT ST
BRANDON MS
39042
US

IV. Provider business mailing address

PO BOX 5043
JACKSON MS
39296-5043
US

V. Phone/Fax

Practice location:
  • Phone: 601-825-7280
  • Fax: 601-825-8130
Mailing address:
  • Phone: 601-957-2343
  • Fax: 601-957-2344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberMS260691
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: