Provider Demographics
NPI:1720522535
Name:SAMMONS, MARION STACIE (NP-C)
Entity Type:Individual
Prefix:
First Name:MARION
Middle Name:STACIE
Last Name:SAMMONS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 CIRCLE J DR
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39440-1980
Mailing Address - Country:US
Mailing Address - Phone:601-425-0092
Mailing Address - Fax:601-425-0473
Practice Address - Street 1:30 CIRCLE J DR
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-1980
Practice Address - Country:US
Practice Address - Phone:601-425-0092
Practice Address - Fax:601-425-0473
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-13
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901564363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily