Healthcare Provider Details

I. General information

NPI: 1376645697
Provider Name (Legal Business Name): REBECCA CLAIRE NORTHINGTON C.F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA CLAIRE STONE C.F.N.P.

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 10/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 HOSPITAL RD
FULTON MS
38843-6002
US

IV. Provider business mailing address

123 MAIN ST N
AMORY MS
38821-3416
US

V. Phone/Fax

Practice location:
  • Phone: 662-862-7047
  • Fax: 662-862-7053
Mailing address:
  • Phone: 662-256-7114
  • Fax: 662-256-7116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR869970
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: