Provider Demographics
NPI:1740967520
Name:BEANSTALK PEDIATRICS, PLLC
Entity type:Organization
Organization Name:BEANSTALK PEDIATRICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:P
Authorized Official - Last Name:BARNES-WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:769-567-1527
Mailing Address - Street 1:320 W JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-2222
Mailing Address - Country:US
Mailing Address - Phone:769-567-1527
Mailing Address - Fax:
Practice Address - Street 1:320 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-2222
Practice Address - Country:US
Practice Address - Phone:769-567-1527
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty