Healthcare Provider Details

I. General information

NPI: 1710899885
Provider Name (Legal Business Name): TANYA SUE STARK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 PROMISE LANE RD
JONESBORO AR
72401-6522
US

IV. Provider business mailing address

2118 E LAWSON RD
JONESBORO AR
72404-8257
US

V. Phone/Fax

Practice location:
  • Phone: 870-910-7831
  • Fax: 870-576-4801
Mailing address:
  • Phone: 870-450-3983
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberL22508
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: