Individual
LARRY D STEPHENS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1053 RIVER OAKS DR, FLOWOOD, MS 39232-9595
(601) 969-1430
(601) 709-2117
Mailing address
1053 RIVER OAKS DR, FLOWOOD, MS 39232-9595
(601) 969-1430
(601) 709-2117
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
209021351
IL
367500000X
Certified Registered Nurse Anesthetist
Primary
R852085
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00122204
—
MS
01
—
430002052
MEDICARE
—
Enumeration date
01/19/2006
Last updated
05/24/2021
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