Grace Gore Sturdivant, AU.D.

Primary specialty

AudiologistTaxonomy code 231H00000X

License

A3608 Issued in MS

Practice address

2500 N State St
Jackson, MS 39216-4500

Phone

(601) 815-6000

Fax

(601) 984-5085

NPI assigned

Mar 13, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1331596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395014400000",
    "number": "1558636282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 N STATE ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164500",
            "telephone_number": "601-815-6000",
            "fax_number": "601-984-5085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 N STATE ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164500",
            "telephone_number": "601-815-6000",
            "fax_number": "601-984-5085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STURDIVANT",
        "first_name": "GRACE",
        "middle_name": "GORE",
        "name_prefix": "Mrs.",
        "credential": "AU.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-03-13",
        "last_updated": "2014-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "MS",
            "license": "A3608",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07203769",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01266932",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Noah Thomas Stuckless, RN
• John E Studdard, M.D.
• William Studdard, M.D.
• Tyler Thomas Studt, DMD
• Diana Minasian Stulc, M.D.
• Kristina Lynn Sturdivant, R.D., L.D.
• Sherice Shunta Stutts-Walker
• Angela R Subauste, MD
• Jose Santiago Subauste, M.D.
• Charulochana Subramony, M.D.

• Audiologist in Jackson, MS
• Providers in Jackson, MS by specialty
• Audiologist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.