Healthcare Provider Details

I. General information

NPI: 1942079413
Provider Name (Legal Business Name): STEPHEN PATRICK SWEENEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: STEPHEN PATRICK SWEENEY PMHNP-BC

II. Dates (important events)

Enumeration Date: 12/26/2023
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 W JACKSON ST STE 1-H
RIDGELAND MS
39157-2355
US

IV. Provider business mailing address

PO BOX 2053
RIDGELAND MS
39158-2053
US

V. Phone/Fax

Practice location:
  • Phone: 601-494-5503
  • Fax: 769-200-5509
Mailing address:
  • Phone: 601-494-5503
  • Fax: 769-200-5509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number906514
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number227582
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number53-82755-041
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number36273
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberGAA-NP002326
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: