Provider Demographics
NPI:1407318231
Name:FLEMING, STEPHEN G (ANP)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:G
Last Name:FLEMING
Suffix:
Gender:M
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39301-4195
Mailing Address - Country:US
Mailing Address - Phone:601-703-6721
Mailing Address - Fax:601-703-6799
Practice Address - Street 1:1314 19TH AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4195
Practice Address - Country:US
Practice Address - Phone:601-703-6721
Practice Address - Fax:601-703-6799
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS878688163W00000X
MS904367363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse