Healthcare Provider Details

I. General information

NPI: 1205508140
Provider Name (Legal Business Name): EBENI STEWARD FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2021
Last Update Date: 05/28/2025
Certification Date: 05/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5525 W 12TH ST
LITTLE ROCK AR
72204-1715
US

IV. Provider business mailing address

5525 W 12TH ST
LITTLE ROCK AR
72204-1715
US

V. Phone/Fax

Practice location:
  • Phone: 501-307-7403
  • Fax:
Mailing address:
  • Phone: 501-282-1599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number217703
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number217703
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: