Individual
STEPHANIE P MYERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
2117 BROADWAY DR, HATTIESBURG, MS 39402-3210
(601) 288-8050
Mailing address
2117 BROADWAY DR, HATTIESBURG, MS 39402-3210
(601) 288-8050
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
867360
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03623229
—
MS
01
—
1276690
CAQH NUMBER
MS
01
—
1X9165
MS MEDICARE PTAN FOR PMHNP
MS
Enumeration date
10/24/2014
Last updated
06/27/2024
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