Healthcare Provider Details

I. General information

NPI: 1629399068
Provider Name (Legal Business Name): STEPHANIE A. MCLEOD NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2010
Last Update Date: 06/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W RAILROAD ST
LONG BEACH MS
39560-4517
US

IV. Provider business mailing address

16005 WICKSTRAND RD
BILOXI MS
39532-7665
US

V. Phone/Fax

Practice location:
  • Phone: 228-864-0622
  • Fax: 228-864-7958
Mailing address:
  • Phone: 228-861-7172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR877699
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: