Provider Demographics
NPI:1629272596
Name:FLOWERS, STACY (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:FLOWERS
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 HOLT COLLIER DR STE C
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39183-4408
Mailing Address - Country:US
Mailing Address - Phone:601-597-2362
Mailing Address - Fax:
Practice Address - Street 1:120 HOLT COLLIER DR STE C
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39183-4408
Practice Address - Country:US
Practice Address - Phone:601-597-2362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904186364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Single Specialty