Provider Demographics
NPI:1093821787
Name:STEPHENS, FLORA E
Entity Type:Individual
Prefix:
First Name:FLORA
Middle Name:E
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:351 PEOPLES DR # A
Mailing Address - Street 2:
Mailing Address - City:PONTOTOC
Mailing Address - State:MS
Mailing Address - Zip Code:38863-8990
Mailing Address - Country:US
Mailing Address - Phone:662-489-7777
Mailing Address - Fax:662-489-0065
Practice Address - Street 1:351 PEOPLES DR # A
Practice Address - Street 2:
Practice Address - City:PONTOTOC
Practice Address - State:MS
Practice Address - Zip Code:38863-8990
Practice Address - Country:US
Practice Address - Phone:662-489-7777
Practice Address - Fax:662-489-0065
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR552003363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSP78570Medicare UPIN