Healthcare Provider Details

I. General information

NPI: 1376476135
Provider Name (Legal Business Name): JAMIE STACY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 OFFICE PARK DR STE D
OXFORD MS
38655-3597
US

IV. Provider business mailing address

117 NORTHPOINTE DR
OXFORD MS
38655-7713
US

V. Phone/Fax

Practice location:
  • Phone: 601-380-5110
  • Fax:
Mailing address:
  • Phone: 601-624-4680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberP-1579
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: