MEDICARE: MRS. EMILY JENKINS STIDHAM MSN, 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	902892	MS

General Provider Information

NPI Number	:	1447733910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. EMILY JENKINS STIDHAM MSN, FNP-C

Provider Business Mailing Address
First Line	:	117 ROBERTS CV
Second Line	:
City	:	STARKVILLE
State	:	MS
Zip	:	39759-6649
Country	:	US
Telephone Number	:	601-951-3208
Fax Number	:

Provider Business Practice Location Address
First Line	:	425 HOSPITAL DR STE 5
Second Line	:
City	:	COLUMBUS
State	:	MS
Zip	:	39705-1938
Country	:	US
Telephone Number	:	662-240-0095
Fax Number	:	662-240-0096

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

Provider Enumeration Date	:	09/11/2018
Last Update Date	:	12/09/2021

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