Healthcare Provider Details

I. General information

NPI: 1275180630
Provider Name (Legal Business Name): STEPHANIE M YOUNG APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2019
Last Update Date: 08/16/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 CREASON RD
CORNING AR
72422-1716
US

IV. Provider business mailing address

PO BOX 83
CORNING AR
72422-0083
US

V. Phone/Fax

Practice location:
  • Phone: 870-857-3399
  • Fax: 870-857-3301
Mailing address:
  • Phone: 870-857-3334
  • Fax: 870-857-9934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number121646
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: