Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
JERRY RANDALL STARK, RN
ActiveJERRY RANDALL STARK, RN is a Emergency Nurse healthcare provider located in SOUTHAVEN, Mississippi. NPI 1447507066 is currently active in the NPPES registry. Verify at CMS.
Emergency Nurse · SOUTHAVEN, MS
Registration Details
- NPI Number
- 1447507066
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Aug 14, 2012 (14.019866326173 yrs)
- Last Updated
- Aug 14, 2012
- License
-
R881245 (MS)
Practice Information
- Address
-
848 VALLEY SPRINGS DRSOUTHAVEN, MS, 386714336Browse MS providers · Browse ZIP 38671
- Phone
- 9013377778
- Primary Specialty
-
Emergency Nurse
163WE0003X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.