Provider Demographics
NPI:1558313601
Name:STINSON, MICHAEL (NP)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:STINSON
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 HIGHWAY 90
Mailing Address - Street 2:SUITE 34
Mailing Address - City:GAUTIER
Mailing Address - State:MS
Mailing Address - Zip Code:39553-5306
Mailing Address - Country:US
Mailing Address - Phone:228-497-7900
Mailing Address - Fax:
Practice Address - Street 1:2105 OLD SPANISH TRL
Practice Address - Street 2:
Practice Address - City:GAUTIER
Practice Address - State:MS
Practice Address - Zip Code:39553-6000
Practice Address - Country:US
Practice Address - Phone:228-497-7980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR873233363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLR97171Medicare UPIN