Provider Demographics
NPI:1578640546
Name:STOCKSTILL, NORMA FAYE (LPN)
Entity Type:Individual
Prefix:
First Name:NORMA
Middle Name:FAYE
Last Name:STOCKSTILL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 AMERICAN WAY
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-6664
Mailing Address - Country:US
Mailing Address - Phone:601-799-0154
Mailing Address - Fax:
Practice Address - Street 1:13 AMERICAN WAY
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-6664
Practice Address - Country:US
Practice Address - Phone:601-799-0154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP254245164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00770182Medicaid