Provider Demographics
NPI:1386020113
Name:CHRISTY, STEFANIE TAYLOR (DNP)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:TAYLOR
Last Name:CHRISTY
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 DUTCH LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39702-5500
Mailing Address - Country:US
Mailing Address - Phone:662-329-3808
Mailing Address - Fax:662-329-1440
Practice Address - Street 1:3654B NEW HOPE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39702-8521
Practice Address - Country:US
Practice Address - Phone:662-329-1488
Practice Address - Fax:662-329-1440
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR889351363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics