Healthcare Provider Details

I. General information

NPI: 1487020855
Provider Name (Legal Business Name): STEPHANNIE CAWIEZELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2015
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N 3RD ST STE 1
DARDANELLE AR
72834-3802
US

IV. Provider business mailing address

PO BOX 9662
CONWAY AR
72033-9662
US

V. Phone/Fax

Practice location:
  • Phone: 479-229-6191
  • Fax: 479-229-6194
Mailing address:
  • Phone: 501-852-1363
  • Fax: 501-852-1364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA004502
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: