Healthcare Provider Details

I. General information

NPI: 1295737559
Provider Name (Legal Business Name): STEPHANIE J CARPINO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 11/07/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 GREATHOUSE SPRINGS RD
JOHNSON AR
72762
US

IV. Provider business mailing address

2 CAWDOR LN
BELLA VISTA AR
72715-4511
US

V. Phone/Fax

Practice location:
  • Phone: 479-684-3000
  • Fax:
Mailing address:
  • Phone: 816-885-2147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberE9955
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD112093
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: