Healthcare Provider Details

I. General information

NPI: 1639608813
Provider Name (Legal Business Name): LEONDREA DEANNA STEWART COLLINS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEONDREA DEANNA STEWART FNP-C

II. Dates (important events)

Enumeration Date: 06/09/2017
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 DOGWOOD VIEW PKWY
JACKSON MS
39213-7857
US

IV. Provider business mailing address

297 HIGHWAY 51 STE D
RIDGELAND MS
39157-3423
US

V. Phone/Fax

Practice location:
  • Phone: 601-899-3310
  • Fax:
Mailing address:
  • Phone: 601-790-0922
  • Fax: 601-790-0923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number886015
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: