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General NPI Number Information
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NPI Number | 1598585523
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Entity Type | Individual
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Provider Name | STACIE DAWN SHOEMAKER AGNP-C
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Gender | Female
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Dates
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Enumeration Date | 10/15/2024
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Last Update Date | 01/29/2026
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Provider Practice Location Address
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Address Line | 156 E WALNUT AVE
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City | EUPORA
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State | MS
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Zip | 39744-2027
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Country | US
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Telephone | 731-394-1145
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Fax |
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Provider Business Mailing Address
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Address Line | 3305 ATTALA ROAD 2269
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City | FRENCH CAMP
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State | MS
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Zip | 39745-9628
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Country | US
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Telephone | 254-707-0990
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 1177371
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 908040
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License Number State | MS
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