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General NPI Number Information
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NPI Number | 1376157487
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Entity Type | Individual
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Provider Name | REBEKAH N STALLWORTH APRN
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Gender | Female
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Dates
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Enumeration Date | 09/04/2020
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Last Update Date | 07/28/2023
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Provider Practice Location Address
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Address Line | 4502 LT EUGENE J MAJURE DR
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City | PASCAGOULA
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State | MS
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Zip | 39581-5305
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Country | US
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Telephone | 228-696-9224
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Fax | 228-696-9228
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Provider Business Mailing Address
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Address Line | 2101 HIGHWAY 90
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City | GAUTIER
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State | MS
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Zip | 39553-5340
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Country | US
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Telephone | 228-497-7576
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 903918
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License Number State | MS
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