Healthcare Provider Details

I. General information

NPI: 1437827912
Provider Name (Legal Business Name): MISTY O'STEEN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2021
Last Update Date: 09/01/2021
Certification Date: 09/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 US-65
HARRISON AR
72601
US

IV. Provider business mailing address

16355 HIGHWAY 412
ALPENA AR
72611-8999
US

V. Phone/Fax

Practice location:
  • Phone: 870-204-7263
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number214646
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: