Individual
TERESA STANFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1105 EARL FRYE BLVD, AMORY, MS 38821-5500
(662) 256-9327
Mailing address
123 MAIN ST N, AMORY, MS 38821-3416
(662) 256-7112
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R613878
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
121431
—
MS
Enumeration date
08/01/2006
Last updated
12/07/2009
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