Provider Demographics
NPI:1164747986
Name:MONROE, STEPHANIE DANIELLE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:DANIELLE
Last Name:MONROE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:297 HIGHWAY 51 STE B
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-3423
Mailing Address - Country:US
Mailing Address - Phone:601-707-5381
Mailing Address - Fax:601-707-5382
Practice Address - Street 1:297 HIGHWAY 51 STE B
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-3423
Practice Address - Country:US
Practice Address - Phone:601-707-5381
Practice Address - Fax:601-707-5382
Is Sole Proprietor?:No
Enumeration Date:2010-04-05
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR853601363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS12085911OtherCAQH
MS02482207Medicaid