Healthcare Provider Details

I. General information

NPI: 1205353794
Provider Name (Legal Business Name): CHANDRA STOKES HURT PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHANDRA ALLISON STOKES

II. Dates (important events)

Enumeration Date: 08/24/2017
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 HIGHWAY 72 W
CORINTH MS
38834-5511
US

IV. Provider business mailing address

150 COUNTY ROAD 543
RIPLEY MS
38663-9406
US

V. Phone/Fax

Practice location:
  • Phone: 662-287-8304
  • Fax: 662-287-8245
Mailing address:
  • Phone: 662-210-0571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberE-010148
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberE-010148
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: