Provider Demographics
NPI:1821565235
Name:CAGLE, STEPHANIE K (FNP)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:K
Last Name:CAGLE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 S THOMAS ST STE 120-121
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-5330
Mailing Address - Country:US
Mailing Address - Phone:662-891-8662
Mailing Address - Fax:662-269-1775
Practice Address - Street 1:218 S THOMAS ST STE 120-121
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801
Practice Address - Country:US
Practice Address - Phone:662-891-8662
Practice Address - Fax:662-269-1775
Is Sole Proprietor?:No
Enumeration Date:2018-10-24
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN24782363LF0000X
MSR902616363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily