Healthcare Provider Details

I. General information

NPI: 1770420770
Provider Name (Legal Business Name): JUSHUNTA YUVONI STEPHENS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1970 HOSPITAL DR
CLARKSDALE MS
38614-7202
US

IV. Provider business mailing address

PO BOX 395
CLARKSDALE MS
38614-0395
US

V. Phone/Fax

Practice location:
  • Phone: 662-627-3211
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number908388
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: