Healthcare Provider Details

I. General information

NPI: 1437309978
Provider Name (Legal Business Name): STACEY S PATTERSON APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2008
Last Update Date: 10/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2725 HIGHWAY 51 S
HERNANDO MS
38632
US

IV. Provider business mailing address

303 N MADISON ST
CORINTH MS
38834-5072
US

V. Phone/Fax

Practice location:
  • Phone: 662-449-1808
  • Fax:
Mailing address:
  • Phone: 662-728-2185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number852219
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: