Healthcare Provider Details

I. General information

NPI: 1982133161
Provider Name (Legal Business Name): KAYLA N STANAGE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1661 AIRPORT RD STE F
HOT SPRINGS AR
71913-8184
US

IV. Provider business mailing address

1661 AIRPORT RD STE F
HOT SPRINGS AR
71913-8184
US

V. Phone/Fax

Practice location:
  • Phone: 501-651-4300
  • Fax: 501-547-5688
Mailing address:
  • Phone: 501-651-4300
  • Fax: 501-547-5688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberATP-001143
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: