Individual
LEITA N STARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
5500 HIGHWAY 363, MANTACHIE, MS 38855-7197
(662) 282-4226
Mailing address
95 IVIE LN, MANTACHIE, MS 38855-8383
(662) 322-3278
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R862379
MS
Other
Enumeration date
11/17/2009
Last updated
11/17/2009
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