Healthcare Provider Details

I. General information

NPI: 1316193345
Provider Name (Legal Business Name): STEPHANIE NICOLE DUFFEL APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. STEPHANIE NICOLE EASLEY

II. Dates (important events)

Enumeration Date: 08/11/2008
Last Update Date: 01/30/2024
Certification Date: 01/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9146 HIGHWAY 63 N
BONO AR
72416-8153
US

IV. Provider business mailing address

9146 HIGHWAY 63 N
BONO AR
72416-8153
US

V. Phone/Fax

Practice location:
  • Phone: 870-930-9990
  • Fax:
Mailing address:
  • Phone: 870-930-9990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA03142
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: