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General NPI Number Information
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NPI Number | 1528486289
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Entity Type | Individual
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Provider Name | THOMAS STALLWORTH ARNP
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Gender | Male
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Dates
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Enumeration Date | 03/31/2014
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Last Update Date | 10/19/2021
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Provider Practice Location Address
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Address Line | 3980G AIRPORT BLVD
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City | MOBILE
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State | AL
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Zip | 36608-2224
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Country | US
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Telephone | 251-318-2603
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Fax | 251-318-2604
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Provider Business Mailing Address
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Address Line | 4105 HOSPITAL ST STE 104
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City | PASCAGOULA
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State | MS
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Zip | 39581-5312
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Country | US
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Telephone | 228-762-9595
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Fax | 287-629-4942
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 902668
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 9331690
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 1-114845
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License Number State | AL
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