Individual
JACKIE B STUCKEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CFNP
Contact information
Practice address
62 HIGHWAY 587, FOXWORTH, MS 39483
(601) 424-3540
(601) 424-3544
Mailing address
PO BOX 669, FOXWORTH, MS 39483
(601) 424-3540
(601) 424-3544
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R805328
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09372826
—
MS
Enumeration date
07/25/2006
Last updated
09/27/2013
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