Healthcare Provider Details

I. General information

NPI: 1780833384
Provider Name (Legal Business Name): STACEY LYNN BUSBY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2008
Last Update Date: 09/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 LESLIE ST
NASHVILLE AR
71852-4015
US

IV. Provider business mailing address

800 LESLIE ST
NASHVILLE AR
71852-4015
US

V. Phone/Fax

Practice location:
  • Phone: 870-845-4400
  • Fax: 870-845-8284
Mailing address:
  • Phone: 870-845-4400
  • Fax: 870-845-8284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number972
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: