1215020714 NPI number — DR. JOSEPHINE H. STOUTER PH.D.

Table of content: DR. JOSEPHINE H. STOUTER PH.D. (NPI 1215020714)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215020714 NPI number — DR. JOSEPHINE H. STOUTER PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STOUTER
Provider First Name:
JOSEPHINE
Provider Middle Name:
H.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOFFMAN
Provider Other First Name:
JOSEPHINE
Provider Other Middle Name:
T.
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PH.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1215020714
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1910 LAKELAND DRIVE, SUITE C
Provider Second Line Business Mailing Address:
QUEST,
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-713-1550
Provider Business Mailing Address Fax Number:
601-713-0122

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1910 LAKELAND DRIVE, SUITE C
Provider Second Line Business Practice Location Address:
QUEST,
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-713-1550
Provider Business Practice Location Address Fax Number:
601-713-0122
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  44712 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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