Provider Demographics
NPI:1497925465
Name:HESS, STACI RENEE (NP)
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:RENEE
Last Name:HESS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:STACI
Other - Middle Name:
Other - Last Name:LUMPKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2778
Mailing Address - Street 2:
Mailing Address - City:BAY ST LOUIS
Mailing Address - State:MS
Mailing Address - Zip Code:39520
Mailing Address - Country:US
Mailing Address - Phone:228-467-2555
Mailing Address - Fax:228-467-5480
Practice Address - Street 1:1009 BENIGNO LANE
Practice Address - Street 2:
Practice Address - City:BAY ST LOUIS
Practice Address - State:MS
Practice Address - Zip Code:39520
Practice Address - Country:US
Practice Address - Phone:228-467-2555
Practice Address - Fax:228-467-5480
Is Sole Proprietor?:No
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR875666363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health