Healthcare Provider Details

I. General information

NPI: 1033511449
Provider Name (Legal Business Name): STEPHANIE MCMELLON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2014
Last Update Date: 09/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E OAK AVE
JONESBORO AR
72401-4163
US

IV. Provider business mailing address

201 E OAK AVE
JONESBORO AR
72401-4163
US

V. Phone/Fax

Practice location:
  • Phone: 870-935-6729
  • Fax: 870-268-4410
Mailing address:
  • Phone: 870-935-6729
  • Fax: 870-268-4410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberS002289
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: