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General NPI Number Information
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NPI Number | 1396910865
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Entity Type | Individual
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Provider Name | STACEY STANFORD NNP
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Gender | Female
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Dates
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Enumeration Date | 04/25/2008
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Last Update Date | 04/26/2022
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Provider Practice Location Address
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Address Line | 5 RIVER BEND PLACE SUITE C
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City | FLOWOOD
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State | MS
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Zip | 39232
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Country | US
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Telephone | 601-957-7345
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Fax | 769-251-5429
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Provider Business Mailing Address
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Address Line | P O BOX 320039
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City | FLOWOOD
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State | MS
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Zip | 39232
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Country | US
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Telephone | 601-957-7345
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Fax | 769-251-5924
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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 | 163WN0002X
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Taxonomy Name | Neonatal Intensive Care Registered Nurse
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License Number | R851094
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 363LN0000X
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Taxonomy Name | Neonatal Nurse Practitioner
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License Number | 223815
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 363LN0000X
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Taxonomy Name | Neonatal Nurse Practitioner
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License Number | R851094
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License Number State | MS
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