Healthcare Provider Details

I. General information

NPI: 1407129505
Provider Name (Legal Business Name): LENA ANNETTE STONER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2012
Last Update Date: 02/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5520 CORDOVA LN
JONESBORO AR
72404-7814
US

IV. Provider business mailing address

5520 CORDOVA LN
JONESBORO AR
72404-7814
US

V. Phone/Fax

Practice location:
  • Phone: 870-761-1024
  • Fax:
Mailing address:
  • Phone: 870-761-1024
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number117674
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: