Healthcare Provider Details

I. General information

NPI: 1629182308
Provider Name (Legal Business Name): MARIA M STEPHENS CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 DUTCH LN
COLUMBUS MS
39702-5500
US

IV. Provider business mailing address

450 E PRESIDENT AVE
TUPELO MS
38801-5599
US

V. Phone/Fax

Practice location:
  • Phone: 662-377-3808
  • Fax: 662-377-3873
Mailing address:
  • Phone: 662-377-4685
  • Fax: 662-377-2755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR826774
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: