Healthcare Provider Details

I. General information

NPI: 1821565235
Provider Name (Legal Business Name): STEPHANIE K CAGLE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2018
Last Update Date: 11/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 S THOMAS ST STE 120-121
TUPELO MS
38801
US

IV. Provider business mailing address

218 S THOMAS ST STE 120-121
TUPELO MS
38801-5330
US

V. Phone/Fax

Practice location:
  • Phone: 662-891-8662
  • Fax: 662-269-1775
Mailing address:
  • Phone: 662-891-8662
  • Fax: 662-269-1775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN24782
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR902616
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: