Provider Demographics
NPI:1659325306
Name:STEGALL, AVA LYNN (DO)
Entity type:Individual
Prefix:
First Name:AVA
Middle Name:LYNN
Last Name:STEGALL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-2156
Mailing Address - Country:US
Mailing Address - Phone:662-615-3731
Mailing Address - Fax:626-615-3737
Practice Address - Street 1:302 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-2156
Practice Address - Country:US
Practice Address - Phone:662-615-3731
Practice Address - Fax:662-615-3737
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS14114207Q00000X
FLOS 5130207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF04334Medicare UPIN