Jerry Lee Stork, PA - Medicare Physician Assistant in Hattiesburg, MS

Jerry Lee Stork, PA is a medicare enrolled "Physician Assistant" in Hattiesburg, Mississippi. His current practice location is 3688 Veterans Memorial Dr, 200, Hattiesburg, Mississippi. You can reach out to his office (for appointments etc.) via phone at (601) 554-7402.

Jerry Lee Stork is licensed to practice in Mississippi (license number PA00079) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1467479550.

Contact Information

Jerry Lee Stork, PA
3688 Veterans Memorial Dr, 200,
Hattiesburg, MS 39401-8246
(601) 554-7402
(601) 554-7488



Provider's Profile

Full NameJerry Lee Stork
GenderMale
SpecialityPhysician Assistant
Location3688 Veterans Memorial Dr, Hattiesburg, Mississippi
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1467479550
  • Provider Enumeration Date: 07/16/2006
  • Last Update Date: 10/19/2021
  Medicare PECOS Information:
  • PECOS PAC ID: 7012922875
  • Enrollment ID: I20060215000300

Medical Identifiers

Medical identifiers for Jerry Lee Stork such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1467479550NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
363AM0700XPhysician Assistant - Medical PA9103513 (Florida)Secondary
363A00000XPhysician Assistant PA00079 (Mississippi)Primary

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Jerry Lee Stork is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Jerry Lee Stork, PA
3688 Veterans Memorial Dr, 200,
Hattiesburg, MS 39401-8246

Ph: (601) 554-7402
Jerry Lee Stork, PA
3688 Veterans Memorial Dr, 200,
Hattiesburg, MS 39401-8246

Ph: (601) 554-7402

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Physician Assistant Nurses in Hattiesburg, MS

Lauren Marie Worley, PA-C
Physician Assistant
Medicare: Medicare Enrolled
Practice Location: 6051 U S Highway 49, Hattiesburg, MS 39401
Phone: 601-288-7000    
Stacey Joyner, CSFA
Physician Assistant
Medicare: Not Enrolled in Medicare
Practice Location: 111 Comanche Dr, Hattiesburg, MS 39402
Phone: 601-604-2858    
Riley Phillips, PA-C
Physician Assistant
Medicare: Accepting Medicare Assignments
Practice Location: 3688 Veterans Memorial Dr, Hattiesburg, MS 39401
Phone: 601-554-7400    Fax: 601-554-7499
Clifton H Davis, P.A.-C
Physician Assistant
Medicare: Accepting Medicare Assignments
Practice Location: 3688 Veterans Memorial Dr, Suite 200, Hattiesburg, MS 39401
Phone: 601-554-7400    Fax: 601-554-7488
Mr. Jimmie G Moore Jr., PA-C
Physician Assistant
Medicare: Accepting Medicare Assignments
Practice Location: 3688 Veterans Memorial Dr, Suite 200, Hattiesburg, MS 39401
Phone: 601-554-7400    Fax: 601-554-7488
Micah Childs, PA-C
Physician Assistant
Medicare: Accepting Medicare Assignments
Practice Location: 3688 Veteran Memorial Drive, Hattiesburg, MS 39402
Phone: 601-554-7400    
Marshall Bynum, PA
Physician Assistant
Medicare: Accepting Medicare Assignments
Practice Location: 3688 Veterans Memorial Dr, Suite 200, Hattiesburg, MS 39401
Phone: 601-554-7400    Fax: 601-554-7499

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