MEDICARE: STEPHANIE MELINDA MYERS

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	904045	MS

General Provider Information

NPI Number	:	1316557416
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE MELINDA MYERS

Provider Business Mailing Address
First Line	:	11310 STEWART WEIR RD
Second Line	:
City	:	STEWART
State	:	MS
Zip	:	39767-5625
Country	:	US
Telephone Number	:	662-552-2008
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 WOODLAND DR # 1530
Second Line	:
City	:	WINONA
State	:	MS
Zip	:	38967-1530
Country	:	US
Telephone Number	:	662-283-3060
Fax Number	:

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

Provider Enumeration Date	:	08/04/2020
Last Update Date	:	08/04/2020

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Directions to “ STEPHANIE MELINDA MYERS ” Practice Location

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