Provider Demographics
NPI:1780832741
Name:VINSON, STELLA LOUISE (NP)
Entity Type:Individual
Prefix:MS
First Name:STELLA
Middle Name:LOUISE
Last Name:VINSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36420-5311
Mailing Address - Country:US
Mailing Address - Phone:334-222-1583
Mailing Address - Fax:334-222-1573
Practice Address - Street 1:215 MEDICAL PARK DR
Practice Address - Street 2:SUITE 1
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420-5311
Practice Address - Country:US
Practice Address - Phone:334-222-1583
Practice Address - Fax:334-222-1573
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1061816363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALPENDINGMedicaid
ALPENDINGMedicare PIN