Healthcare Provider Details

I. General information

NPI: 1295386613
Provider Name (Legal Business Name): STEPHANIE LANELL BURNETT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2019
Last Update Date: 03/19/2020
Certification Date: 03/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2796 S 2ND ST STE E
CABOT AR
72023-7043
US

IV. Provider business mailing address

21415 CHISM DR
NORTH LITTLE ROCK AR
72113-9705
US

V. Phone/Fax

Practice location:
  • Phone: 501-286-6086
  • Fax:
Mailing address:
  • Phone: 501-765-8390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number121996
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: