MEDICARE: REGINA ANN STONE FNP-C

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
1	363LF0000X	Family Nurse Practitioner	RN113482	GA

General Provider Information

NPI Number	:	1154862894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REGINA ANN STONE FNP-C

Provider Business Mailing Address
First Line	:	1003 SHIRLEY AVE
Second Line	:
City	:	DOUGLAS
State	:	GA
Zip	:	31533-2123
Country	:	US
Telephone Number	:	912-389-4586
Fax Number	:	912-389-4590

Provider Business Practice Location Address
First Line	:	1003 SHIRLEY AVE
Second Line	:
City	:	DOUGLAS
State	:	GA
Zip	:	31533-2123
Country	:	US
Telephone Number	:	912-389-4586
Fax Number	:	912-389-4590

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2017
Last Update Date	:	03/14/2017

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