LEITA N STARK (NPI# 1760719447) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760719447 |
| Entity Type | Individual |
| Full Name | LEITA N STARK |
| Credential | FNP-BC |
| Practice Address |
5500 Highway 363 Mantachie MS 38855-7197 |
| Mailing Address |
95 Ivie Ln Mantachie MS 38855-8383 |
| Practice Telephone | 6622824226 |
| Mailing Telephone | 6623223278 |
| Enumeration Date | 2009-11-17 |
| Last Update Date | 2009-11-17 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
R862379 | MS | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
5500 HIGHWAY 363 |
| City | MANTACHIE |
| State | MS |
| Zip Code | 38855-7197 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215312335 | Timothy Gillespie | Social Worker | 5500 Highway 363, Mantachie, MS 38855-7197 | 2015-07-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356997985 | Sonshine Pharmacy, LLC | Pharmacy | 2745 Highway 371 N, Mantachie, MS 38855 | 2019-08-09 |
| 1053885673 | Mantachie Rural Health Care, Inc | Clinic/Center | 311 Mustang Drive, Mantachie, MS 38855 | 2019-01-16 |
| 1992292536 | Mantachie Pharmacy LLC | Pharmacy | 3309 Highway 371 N, Mantachie, MS 38855 | 2018-04-19 |
| 1720589070 | Mantachie Rural Health Care Inc Behavioral Health | Clinic/Center | 5510 Hwy 363, Mantachie, MS 38855 | 2018-02-22 |
| 1962816447 | Travis Castleberry | Physical Therapist | 230a Main Street, Nettleton, MS 38855 | 2014-06-12 |
| 1891907093 | Community Family Healthcare, Inc | Nurse Practitioner | 285 Ivie Lane, Mantachie, MS 38855 | 2007-05-03 |
| 1750307328 | Freds Stores of Tennessee Inc | Durable Medical Equipment & Medical Supplies | 67 Watson Dr, Mantachie, MS 38855 | 2006-07-15 |
| 1497063085 | Jennifer Emily Bass | Specialist | 275 Morning View Lane, Mantachie, MS 38855-7096 | 2010-09-17 |
| 1780169557 | Andrea Carpenter | Nurse Practitioner | 3275 Highway 371 N, Mantachie, MS 38855-7145 | 2018-09-27 |
| 1164987426 | Hometown Care of Mantachie LLC | Nurse Practitioner | 3275 Highway 371 N, Mantachie, MS 38855-7145 | 2019-01-31 |
| Find all providers in zip 38855 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780169557 | Andrea Carpenter | Nurse Practitioner | 3275 Highway 371 N, Mantachie, MS 38855-7145 | 2018-09-27 |
| 1891907093 | Community Family Healthcare, Inc | Nurse Practitioner | 285 Ivie Lane, Mantachie, MS 38855 | 2007-05-03 |
| 1164987426 | Hometown Care of Mantachie LLC | Nurse Practitioner | 3275 Highway 371 N, Mantachie, MS 38855-7145 | 2019-01-31 |
| 1700340908 | Amy Lynn Floyd | Nurse Practitioner | 5681 Highway 363, Mantachie, MS 38855-7632 | 2019-01-22 |
| 1851876627 | Kristi Diann Graves | Nurse Practitioner | 3275 Highway 371 N, Mantachie, MS 38855-7145 | 2018-09-27 |
| 1932589058 | Kathryn Claire Wright | Nurse Practitioner | 5681 Highway 363, Mantachie, MS 38855-7632 | 2015-06-03 |
| 1770824955 | Kimberly M Stanley | Nurse Practitioner | 285 Ivie Ln, Mantachie, MS 38855-9764 | 2013-03-12 |
| 1659681328 | Crystal Jo Nichols | Nurse Practitioner | 285 Ivie Ln, Mantachie, MS 38855-9764 | 2010-10-15 |
| 1710115506 | Leslie Ellen Peterson | Nurse Practitioner | 5681 Highway 363, Mantachie, MS 38855-7197 | 2009-06-30 |
| 1356538045 | Amanda Leigh Martin | Nurse Practitioner | 5681 Highway 363, Mantachie, MS 38855-7632 | 2007-09-26 |
| Find all providers in MANTACHIE | ||||
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| 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.