Provider Demographics
NPI:1942079413
Name:SWEENEY, STEPHEN PATRICK
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:PATRICK
Last Name:SWEENEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:STEPHEN
Other - Middle Name:PATRICK
Other - Last Name:SWEENEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:105 WOODGATE DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-2115
Mailing Address - Country:US
Mailing Address - Phone:601-540-3520
Mailing Address - Fax:
Practice Address - Street 1:105 WOODGATE DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:MS
Practice Address - Zip Code:39042-2115
Practice Address - Country:US
Practice Address - Phone:601-540-3520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-26
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-82755-041363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health