Healthcare Provider Details

I. General information

NPI: 1811191620
Provider Name (Legal Business Name): JACQUELYN AMBER STONE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 MARTIN L KING JR PKWY
SNOW HILL NC
28580-1320
US

IV. Provider business mailing address

4423 FLY ROD TER
PARRISH FL
34219-3109
US

V. Phone/Fax

Practice location:
  • Phone: 252-747-8162
  • Fax: 252-747-8163
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number065800
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number32879
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number302051
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2016-02173
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: