Provider Demographics
NPI:1003516113
Name:STEGALL FAMILY CARE
Entity type:Organization
Organization Name:STEGALL FAMILY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STEGALL
Authorized Official - Suffix:
Authorized Official - Credentials:CFNP
Authorized Official - Phone:662-419-9148
Mailing Address - Street 1:395 TIMBER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:PONTOTOC
Mailing Address - State:MS
Mailing Address - Zip Code:38863-8043
Mailing Address - Country:US
Mailing Address - Phone:662-419-9148
Mailing Address - Fax:
Practice Address - Street 1:395 TIMBER CREEK DR
Practice Address - Street 2:
Practice Address - City:PONTOTOC
Practice Address - State:MS
Practice Address - Zip Code:38863-8043
Practice Address - Country:US
Practice Address - Phone:662-419-9148
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-07
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty