Individual
STACY RAE ANDREACCHIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FPMHNP
Contact information
Practice address
5004 HIGHWAY 39 N, MERIDIAN, MS 39301-1021
(601) 693-8307
(601) 693-6794
Mailing address
PO BOX 8068, MERIDIAN, MS 39303-8068
(601) 693-8307
(601) 639-6794
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R828589
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08903768
—
MS
Enumeration date
01/12/2006
Last updated
05/19/2008
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