Healthcare Provider Details

I. General information

NPI: 1710513924
Provider Name (Legal Business Name): STEPHANIE BURNETT APRN, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2020
Last Update Date: 04/01/2020
Certification Date: 04/01/2020
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: 501-286-6046
Mailing address:
  • Phone: 501-765-8390
  • Fax: 501-286-6046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE BURNETT
Title or Position: OWNER
Credential: APRN
Phone: 501-765-8390