Provider Demographics
NPI:1942079413
Name:SWEENEY, STEPHEN PATRICK
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:PATRICK
Last Name:SWEENEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:STEPHEN
Other - Middle Name:PATRICK
Other - Last Name:SWEENEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMHNP-BC
Mailing Address - Street 1:745 AVIGNON DR STE C
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-5186
Mailing Address - Country:US
Mailing Address - Phone:601-540-3520
Mailing Address - Fax:
Practice Address - Street 1:745 AVIGNON DR STE C
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-5186
Practice Address - Country:US
Practice Address - Phone:601-540-3520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-26
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGAA-NP0023262084P0800X
AR2275822084P0800X
TN36273363LP0808X
KS53-82755-041363LP0808X
MS9065142084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health