Healthcare Provider Details

I. General information

NPI: 1558313601
Provider Name (Legal Business Name): MICHAEL STINSON N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 06/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 OLD SPANISH TRL
GAUTIER MS
39553-6000
US

IV. Provider business mailing address

2012 HIGHWAY 90 SUITE 34
GAUTIER MS
39553-5306
US

V. Phone/Fax

Practice location:
  • Phone: 228-497-7980
  • Fax:
Mailing address:
  • Phone: 228-497-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR873233
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: