Individual
MS. STACEY DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2500 N STATE ST, PFS, JACKSON, MS 39216-4500
(601) 984-4619
(601) 984-4657
Mailing address
2500 N STATE ST, PFS, JACKSON, MS 39216-4500
(601) 984-4619
(601) 984-4657
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R706574
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00123294
—
MS
Enumeration date
12/28/2006
Last updated
10/06/2014
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