Healthcare Provider Details

I. General information

NPI: 1649205006
Provider Name (Legal Business Name): ANNE WARD STEVENS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 03/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

86 W SUNBRIDGE DR
FAYETTEVILLE AR
72703-1822
US

IV. Provider business mailing address

86 W SUNBRIDGE DR
FAYETTEVILLE AR
72703-1822
US

V. Phone/Fax

Practice location:
  • Phone: 479-435-6360
  • Fax: 479-435-6028
Mailing address:
  • Phone: 479-435-6360
  • Fax: 479-435-6028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number97-19P
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: