Provider Demographics
NPI:1558662965
Name:STONE, LALETA SHERESE (NP)
Entity Type:Individual
Prefix:MRS
First Name:LALETA
Middle Name:SHERESE
Last Name:STONE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LALETA
Other - Middle Name:SHERESE
Other - Last Name:DOBBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:204 EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-2320
Mailing Address - Country:US
Mailing Address - Phone:662-312-5982
Mailing Address - Fax:
Practice Address - Street 1:509 STATE HIGHWAY 15 S
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:MS
Practice Address - Zip Code:38652-4502
Practice Address - Country:US
Practice Address - Phone:662-534-4330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-16
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR863491363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00134207Medicaid
MS00134207Medicaid