Healthcare Provider Details

I. General information

NPI: 1649550708
Provider Name (Legal Business Name): TERESA KAYE STEGALL N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2011
Last Update Date: 07/13/2024
Certification Date: 07/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 SUNSET DR STE A
GRENADA MS
38901-4081
US

IV. Provider business mailing address

700 SUNSET DR
GRENADA MS
38901-4091
US

V. Phone/Fax

Practice location:
  • Phone: 662-226-1646
  • Fax: 662-227-1599
Mailing address:
  • Phone: 662-307-2884
  • Fax: 662-307-2887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR831167
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberMSR831167
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: