Healthcare Provider Details

I. General information

NPI: 1407301237
Provider Name (Legal Business Name): STEPHANIE RACHELLE LUMPKIN-FREEMAN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2016
Last Update Date: 08/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 READ RD
PICAYUNE MS
39466-2730
US

IV. Provider business mailing address

PO BOX 1729
HATTIESBURG MS
39403-1729
US

V. Phone/Fax

Practice location:
  • Phone: 601-251-3500
  • Fax: 601-251-3504
Mailing address:
  • Phone: 601-545-8700
  • Fax: 601-450-2493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR901595
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: