Provider Demographics
NPI:1336405455
Name:RAMSEY, STACIE L (FNP-BC)
Entity Type:Individual
Prefix:
First Name:STACIE
Middle Name:L
Last Name:RAMSEY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9454 THREE RIVERS RD STE D
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-4294
Mailing Address - Country:US
Mailing Address - Phone:228-863-0500
Mailing Address - Fax:
Practice Address - Street 1:9454 THREE RIVERS RD STE D
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-4294
Practice Address - Country:US
Practice Address - Phone:228-863-0500
Practice Address - Fax:228-863-0502
Is Sole Proprietor?:No
Enumeration Date:2012-04-03
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR882663363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily