St Dominic Medical Associates LLC
NPI #1508263179 in Jackson, Mississippi
Provider Information
- NPI Number
- 1508263179
- Entity Type
- Organization
- Organization Name
- St Dominic Medical Associates LLC
- Subpart
- Yes (part of a larger organization)
- Parent Organization
- ST DOMINIC JACKSON MEMORIAL HOSPITAL
- Primary Specialty
- Nurse Practitioner - Family
- Enumeration Date
- Nov 26, 2014
- Last Updated
- Oct 18, 2021
Practice Location
- Address
- 890 LAKELAND DR
- City
- Jackson
- State
- Mississippi
- ZIP Code
- 39216-4644
- Phone
- (601) 200-3131
Authorized Official
- Name
- DANIELLE STUART
- Title
- CREDENTIALING REPRESENTATIVE 2
- Phone
- (601) 200-4880
Specialties & Taxonomy Codes
| Specialty |
|---|
| Nurse Practitioner - Family — Family |
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