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General NPI Number Information
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NPI Number | 1174309819
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Entity Type | Organization
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Legal Business Name | DELTA PHOENIX MEDICAL CONSULTING
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Dates
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Enumeration Date | 09/07/2023
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Last Update Date | 11/07/2023
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Provider Practice Location Address
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Address Line | 940 CHURCH RD W STE A2
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City | SOUTHAVEN
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State | MS
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Zip | 38671-9611
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Country | US
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Telephone | 662-231-8436
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Fax | 662-536-6640
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Provider Business Mailing Address
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Address Line | 940 CHURCH RD W STE A2
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City | SOUTHAVEN
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State | MS
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Zip | 38671-9611
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Country | US
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Telephone | 662-231-8436
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Fax |
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Authorized Official
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Title or Position | OWNER SOLE PROPRIETOR
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Name | MONICA JOY STANFORD
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Credential | FNP-C
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Telephone | 662-231-8436
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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