Healthcare Provider Details

I. General information

NPI: 1760720155
Provider Name (Legal Business Name): STACI CAROL DAILY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2013
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1014 HARKRIDER ST STE B
CONWAY AR
72032-4404
US

IV. Provider business mailing address

1014 HARKRIDER ST STE B
CONWAY AR
72032-4404
US

V. Phone/Fax

Practice location:
  • Phone: 501-327-7100
  • Fax:
Mailing address:
  • Phone: 501-327-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA09728
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA09728
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number517
License Number StateAR
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2179
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: