Amanda Stauble, APRN
Nurse Practitioner, Family in Jackson, MS. Individual provider (NPI-1).
NPI number1063768331
StatusActive
Last updated in NPPESAug 22, 2019
Details
- NPI
- 1063768331
- Entity type
- Individual (NPI-1)
- Name
- Amanda Stauble
- Credential
- APRN
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jul 24, 2012
- Last updated
- Aug 22, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LF0000X | Nurse Practitioner, Family | 903113 | MS | Yes |
Practice location
1225 N State StJackson, MS 39202
Phone 601-201-7188
Mailing address
104 Woodstock DrVicksburg, MS 39180-5747
Phone 601-201-7188
Other practice locations
501 Marshall St Ste 104
Jackson, MS 39202-1663
Jackson, MS 39202-1663
Phone 601-969-6404
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