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NPI Code Detail

MEDICARE: STEPHANIE RAY FNP

MEDICARE: STEPHANIE RAY FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner902711MS

General Provider Information

NPI Number : 1124513213
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE RAY FNP
Provider Business Mailing Address
First Line : 118 HIGH ST
Second Line :
City : BRANDON
State : MS
Zip : 39042-3719
Country : US
Telephone Number : 601-573-1393
Fax Number :
Provider Business Practice Location Address
First Line : 670 WEATHERSBY RD STE 140
Second Line :
City : HATTIESBURG
State : MS
Zip : 39402-9586
Country : US
Telephone Number : 601-573-1393
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/29/2018
Last Update Date : 01/05/2026

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