Healthcare Provider Details

I. General information

NPI: 1083522189
Provider Name (Legal Business Name): STEPHEN HOUCK JR. RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4436 MANGUM DR
FLOWOOD MS
39232-2113
US

IV. Provider business mailing address

207 ACADIA LN
MADISON MS
39110-8454
US

V. Phone/Fax

Practice location:
  • Phone: 601-720-9900
  • Fax: 601-586-7071
Mailing address:
  • Phone: 601-720-9900
  • Fax: 601-586-7071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number896345
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: