Provider Demographics
NPI:1003515578
Name:STONE, MICHAELA (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:STONE
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:MICHAELA
Other - Middle Name:
Other - Last Name:FONTANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP-PC
Mailing Address - Street 1:321 E FIFTEENTH ST
Mailing Address - Street 2:
Mailing Address - City:YAZOO CITY
Mailing Address - State:MS
Mailing Address - Zip Code:39194-2631
Mailing Address - Country:US
Mailing Address - Phone:662-532-1543
Mailing Address - Fax:662-532-1544
Practice Address - Street 1:321 E FIFTEENTH ST
Practice Address - Street 2:
Practice Address - City:YAZOO CITY
Practice Address - State:MS
Practice Address - Zip Code:39194-2631
Practice Address - Country:US
Practice Address - Phone:662-532-1543
Practice Address - Fax:662-532-1544
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS905842363LP0200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics