Healthcare Provider Details

I. General information

NPI: 1427274521
Provider Name (Legal Business Name): KATHI R STAYMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3396 N FUTRALL DR
FAYETTEVILLE AR
72703-4057
US

IV. Provider business mailing address

636 REED VALLEY RD
FAYETTEVILLE AR
72704
US

V. Phone/Fax

Practice location:
  • Phone: 479-582-1938
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744R1103X
TaxonomyResearch Study Abstracter/Coder
License Number01046517
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: