Provider Demographics
NPI:1003515578
Name:STONE, MICHAELA (CPNP-PC)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:STONE
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:MICHAELA
Other - Middle Name:
Other - Last Name:FONTANA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP-PC
Mailing Address - Street 1:840 N OAK AVE
Mailing Address - Street 2:
Mailing Address - City:RULEVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38771-3227
Mailing Address - Country:US
Mailing Address - Phone:662-756-1788
Mailing Address - Fax:662-756-1694
Practice Address - Street 1:840 N OAK AVE
Practice Address - Street 2:
Practice Address - City:RULEVILLE
Practice Address - State:MS
Practice Address - Zip Code:38771-3227
Practice Address - Country:US
Practice Address - Phone:662-756-1788
Practice Address - Fax:662-756-1694
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-23
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS905842363LP0200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics