Healthcare Provider Details

I. General information

NPI: 1740967520
Provider Name (Legal Business Name): BEANSTALK PEDIATRICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2023
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 W JACKSON ST
RIDGELAND MS
39157-2222
US

IV. Provider business mailing address

320 W JACKSON ST
RIDGELAND MS
39157-2222
US

V. Phone/Fax

Practice location:
  • Phone: 769-567-1527
  • Fax:
Mailing address:
  • Phone: 769-567-1527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CONSTANCE P BARNES-WOODS
Title or Position: OWNER
Credential: MD
Phone: 769-567-1527