Individual provider · Type 1 NPI
Jerry Randall Stark, RN
Emergency Registered Nurse · Southaven, MS
NPI number
1447507066
Active
Practice location
848 Valley Springs Dr
Southaven, MS 38671-4336
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Emergency Registered Nurse Primary | 163WE0003X | R881245 (MS) |
Emergency Registered Nurse: Definition to come...
About NPI 1447507066
Jerry Randall Stark, RN's National Provider Identifier is 1447507066, issued on Aug 14, 2012. The primary taxonomy on file is Emergency Registered Nurse (163WE0003X), and the practice location is in Southaven, MS. The record was last updated on Aug 14, 2012.