Healthcare Provider Details

I. General information

NPI: 1538015359
Provider Name (Legal Business Name): STACIA RENEE DAVIS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2026
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11201 NORTHFIELD CT
FORT SMITH AR
72916-9126
US

IV. Provider business mailing address

11201 NORTHFIELD CT
FORT SMITH AR
72916-9126
US

V. Phone/Fax

Practice location:
  • Phone: 479-227-0116
  • Fax:
Mailing address:
  • Phone: 479-227-0116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR096409
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: