Provider Demographics
NPI:1457854408
Name:STRIBLING, LETICIA FAY (FNP-BC)
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:FAY
Last Name:STRIBLING
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 1:117 HANOVER ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110-6028
Mailing Address - Country:US
Mailing Address - Phone:228-263-1523
Mailing Address - Fax:
Practice Address - Street 1:2605 COURTHOUSE CIR
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-9521
Practice Address - Country:US
Practice Address - Phone:601-397-6174
Practice Address - Fax:601-398-2348
Is Sole Proprietor?:No
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902396363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily