Provider Demographics
NPI:1447682729
Name:BEDWELL, STEFFANY (NP)
Entity type:Individual
Prefix:
First Name:STEFFANY
Middle Name:
Last Name:BEDWELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-261-1600
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:1 LINCOLN PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-3262
Practice Address - Country:US
Practice Address - Phone:601-261-1600
Practice Address - Fax:601-264-5133
Is Sole Proprietor?:No
Enumeration Date:2013-08-08
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR863920363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07501353Medicaid