Organization
BAY REJUVENATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALISA STEPHENS NP-C (FAMILY NURSE PRACTITIONER)
(662) 571-0916
Entity
Organization
Contact information
Practice address
309 REESE ST, BAY SAINT LOUIS, MS 39520-2823
(662) 571-0916
Mailing address
309 REESE ST, BAY SAINT LOUIS, MS 39520-2823
(662) 571-0916
Taxonomy
Speciality
Code
Description
License number
State
261QI0500X
Infusion Therapy Clinic/Center
Primary
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
Other
Enumeration date
05/29/2022
Last updated
05/29/2022
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