Provider Demographics
NPI:1659508612
Name:STONEFIELD, DEBORAH DARLENE (CFNP)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH DARLENE
Middle Name:
Last Name:STONEFIELD
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-649-2775
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:2313 HIGHWAY 15 N
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-1805
Practice Address - Country:US
Practice Address - Phone:601-649-2775
Practice Address - Fax:601-649-2686
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-17
Last Update Date:2017-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR623814363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01178221Medicaid