Individual
MRS. STACEY NEUBAUER KITCHENS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-4700
Mailing address
2411 CULLEYWOOD RD, JACKSON, MS 39211-4917
(601) 668-6025
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
902210
MS
Other
Enumeration date
08/16/2017
Last updated
08/16/2017
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