Provider Demographics
NPI:1649550708
Name:STEGALL, TERESA KAYE (NP)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:KAYE
Last Name:STEGALL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38901-4091
Mailing Address - Country:US
Mailing Address - Phone:662-307-2884
Mailing Address - Fax:662-307-2887
Practice Address - Street 1:1300 SUNSET DR
Practice Address - Street 2:STE A
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901-4081
Practice Address - Country:US
Practice Address - Phone:662-226-1646
Practice Address - Fax:662-227-1599
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-22
Last Update Date:2024-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR831167363LF0000X
MSMSR831167363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily