Provider Demographics
NPI:1457796922
Name:STANFORD, MONICA JOY (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:MONICA
Middle Name:JOY
Last Name:STANFORD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:JOY
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:940 CHURCH RD W STE A2
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671-9611
Mailing Address - Country:US
Mailing Address - Phone:662-231-8436
Mailing Address - Fax:626-229-0752
Practice Address - Street 1:940 CHURCH RD W STE A2
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671-9611
Practice Address - Country:US
Practice Address - Phone:662-231-8436
Practice Address - Fax:662-536-6640
Is Sole Proprietor?:No
Enumeration Date:2013-05-09
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR877063363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily