Organization
SPECTRUM THE OTHER CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACIE M PACE CNP (OWNER/DIRECTOR)
(601) 466-9495
Entity
Organization
Contact information
Practice address
709 HARDY ST, HATTIESBURG, MS 39401-3666
(601) 466-9495
(601) 469-9965
Mailing address
2910 MAGNOLIA PL, HATTIESBURG, MS 39402-2428
(601) 466-9495
(601) 469-9965
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
363LA2100X
Acute Care Nurse Practitioner
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
363LP2300X
Primary Care Nurse Practitioner
—
—
Other
Enumeration date
10/17/2019
Last updated
04/06/2021
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