Healthcare Provider Details

I. General information

NPI: 1962311985
Provider Name (Legal Business Name): STEPHANIE ANNETTE JOHNSON LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 AGGIE RD
JONESBORO AR
72405-9319
US

IV. Provider business mailing address

3901 AGGIE RD
JONESBORO AR
72405-9319
US

V. Phone/Fax

Practice location:
  • Phone: 870-336-4700
  • Fax: 870-336-4705
Mailing address:
  • Phone: 870-336-4700
  • Fax: 870-336-4705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberL032794
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: