Healthcare Provider Details

I. General information

NPI: 1871003988
Provider Name (Legal Business Name): STEPHANIE O. HUBBARD CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2017
Last Update Date: 01/18/2024
Certification Date: 01/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 E MADISON STREET
HOUSTON MS
38851
US

IV. Provider business mailing address

1002 E MADISON STREET P.O. BOX 432
HOUSTON MS
38851
US

V. Phone/Fax

Practice location:
  • Phone: 662-456-2037
  • Fax: 662-456-1006
Mailing address:
  • Phone: 662-456-2037
  • Fax: 662-456-1006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number902296
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: