Provider Demographics
NPI:1871003988
Name:HUBBARD, STEPHANIE O (CFNP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:O
Last Name:HUBBARD
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 1:1002 E MADISON STREET
Mailing Address - Street 2:P.O. BOX 432
Mailing Address - City:HOUSTON
Mailing Address - State:MS
Mailing Address - Zip Code:38851
Mailing Address - Country:US
Mailing Address - Phone:662-456-2037
Mailing Address - Fax:662-456-1006
Practice Address - Street 1:1002 E MADISON STREET
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:MS
Practice Address - Zip Code:38851
Practice Address - Country:US
Practice Address - Phone:662-456-2037
Practice Address - Fax:662-456-1006
Is Sole Proprietor?:No
Enumeration Date:2017-10-03
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902296363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily