Provider Demographics
NPI:1588771182
Name:STUART, REBECCA SUE (CFNP)
Entity type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:SUE
Last Name:STUART
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12261 HIGHWAY 49 STE 6
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503-2976
Mailing Address - Country:US
Mailing Address - Phone:228-206-0550
Mailing Address - Fax:501-257-5117
Practice Address - Street 1:12261 HIGHWAY 49 STE 6
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-2976
Practice Address - Country:US
Practice Address - Phone:228-206-0550
Practice Address - Fax:501-257-5117
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03014ANP163W00000X
ARR79157163W00000X
MS810229363LF0000X
MSR78522363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0TH000Medicare UPIN