Organization
DELTA PHYSICIAN PRACTICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IRIS STACKER (CEO)
(662) 378-3783
Entity
Organization
Contact information
Practice address
930 MAIN ST, GREENVILLE, MS 38701-4111
(662) 332-1398
(662) 332-7107
Mailing address
PO BOX 1734, GREENVILLE, MS 38702-1734
(662) 725-2749
(662) 725-2741
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09015100
—
MS
Enumeration date
06/11/2010
Last updated
11/14/2022
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