Provider Demographics
NPI:1679020630
Name:STANFORD, REBECCA (FNP-C)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:STANFORD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:977 EMERGENCY DR
Mailing Address - Street 2:
Mailing Address - City:WEST POINT
Mailing Address - State:MS
Mailing Address - Zip Code:39773-9322
Mailing Address - Country:US
Mailing Address - Phone:662-495-5232
Mailing Address - Fax:662-495-1211
Practice Address - Street 1:977 EMERGENCY DR
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:MS
Practice Address - Zip Code:39773-9322
Practice Address - Country:US
Practice Address - Phone:662-495-5232
Practice Address - Fax:662-495-1211
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901762363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily