JERRY RANDALL STARK


Address: 848 Valley Springs Dr, Southaven, MS 38671-4336
Phone: 9013377778

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).

Provider Overview

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

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 163WE0003X Registered Nurse
Specialization: Emergency
R881245 MS Nursing Service Providers

Office Location

Street Address 848 VALLEY SPRINGS DR
City SOUTHAVEN
State MS
Zip Code 38671-4336

Providers in the same zip code

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
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Taxonomy Information

Taxonomy Code 163WE0003X
Grouping Nursing Service Providers
Classification Registered Nurse
Specialization Emergency

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and state

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
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Competitor

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City SOUTHAVEN
Zip Code 38671

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Dataset Information

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.

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