IndividualActive
Jerry Stark, RN
NPI 1447507066 · Emergency Registered Nurse · Southaven, MS
Provider details
- NPI number
- 1447507066
- Entity type
- Individual
- Primary specialty
- Emergency Registered NurseNursing Service Providers
- Credential
- RN
- Sex
- Male
- Sole proprietor
- No
- License
- R881245 (MS)
Specialties & taxonomies
Nursing Service Providers
Practice location
848 Valley Springs Dr
Southaven, MS 38671-4336
Phone: (901) 337-7778
Approximate (ZIP-level) locationGet directions
Mailing address
848 Valley Springs Dr
Southaven, MS 38671-4336
Registry dates
- Enumerated
- 2012-08-14
- Last updated
- 2012-08-14
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.