JERRY RANDALL STARK (NPI# 1447507066) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1447507066 |
| Entity Type | Individual |
| Full Name | JERRY RANDALL STARK |
| Credential | RN |
| Practice Address |
848 Valley Springs Dr Southaven MS 38671-4336 |
| Practice Telephone | 9013377778 |
| Mailing Telephone | 9013377778 |
| Enumeration Date | 2012-08-14 |
| Last Update Date | 2012-08-14 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 163WE0003X |
Registered Nurse Specialization: Emergency |
R881245 | MS | Nursing Service Providers |
| Street Address |
848 VALLEY SPRINGS DR |
| City | SOUTHAVEN |
| State | MS |
| Zip Code | 38671-4336 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285196196 | Emma Tinsley-bowles Long | Social Worker | 8786 Northcreek Blvd, Bldg 8 Apt 3, Southaven, MS 38671 | 2019-04-01 |
| 1851847586 | Tiffany Lashea Jones | Adult Companion | 8755 Millbranch Road, Southaven, MS 38671 | 2016-09-01 |
| 1538526140 | Desoto Pediatric Extended Care LLC | Skilled Nursing Facility | 750 Stateline Road East, Southhaven, MS 38671 | 2016-01-27 |
| 1073983052 | Tara Burt | Physical Therapist | 7900 Airways Blvd. Building A, Suite 2, Southaven, MS 38671 | 2015-10-02 |
| 1295160463 | Ideal Community Care,llc | In Home Supportive Care | 8869 Centre Str #3, Southaven, MS 38671 | 2013-09-06 |
| 1578995692 | Gregory Charles Eakins Jr. | Optometrist | 338 Goodman Rd West, Southaven, MS 38671 | 2013-07-31 |
| 1295173169 | Erica R. Martin | Social Worker | 975 Swinnea Rdg Ste 3, Southaven, MS 38671 | 2013-06-12 |
| 1386918431 | Freds Stores of Tennessee Inc | Pharmacy | 710 Church Road, Southaven, MS 38671 | 2012-03-06 |
| 1740565613 | Mary Jeanette Scruggs | Pharmacist | 1011 Goodman Rd, Southaven, MS 38671 | 2011-10-11 |
| 1184919268 | First Pharmacy Services 5 | Pharmacy | 5185a Getwell Rd, Southaven, MS 38671 | 2011-06-16 |
| Find all providers in zip 38671 | ||||
| Taxonomy Code | 163WE0003X |
| Grouping | Nursing Service Providers |
| Classification | Registered Nurse |
| Specialization | Emergency |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033723093 | Amber Ryals | Registered Nurse | 13236 Anne Ct, Gulfport, MS 39503-8138 | 2020-09-06 |
| 1407318736 | Alicia Brown | Registered Nurse | 139 Drive 2696, Baldwyn, MS 38824-6842 | 2019-04-04 |
| 1902370018 | Kelsie Follin | Registered Nurse | 93 County Road 533, Corinth, MS 38834-8116 | 2019-01-11 |
| 1528310539 | Lorri Cook | Registered Nurse | 4036 Spring Port Rd., Sardis, MS 38666 | 2012-10-15 |
| 1366774879 | Jennifer L Jurich | Registered Nurse | 8924 Live Oak Ave, Ocean Springs, MS 39564-8540 | 2010-02-08 |
| 1972113439 | Jonathan Adam Giangrosso | Registered Nurse | 300 3rd Ave Se, Magee, MS 39111-3665 | 2020-08-08 |
| 1063038636 | Ayanna Washington | Registered Nurse | 969 Lakeland Dr, Jackson, MS 39216-4606 | 2020-06-19 |
| 1407396997 | Cori Bitner | Registered Nurse | 2500 N State St, Jackson, MS 39216-4500 | 2017-03-02 |
| 1073903894 | Erin Touchstone | Registered Nurse | 350 Crossgates Blvd, Brandon, MS 39042-2601 | 2015-02-01 |
| 1437558061 | Micah Alexander Grant | Registered Nurse | 2430 5th St N, Columbus, MS 39705-2000 | 2014-08-20 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on JERRY RANDALL STARK.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.