Healthcare Provider Details

I. General information

NPI: 1811821291
Provider Name (Legal Business Name): STEPHANIE THREATT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 E MAIN ST
PIGGOTT AR
72454-2822
US

IV. Provider business mailing address

811 COUNTY ROAD 455
PIGGOTT AR
72454-8522
US

V. Phone/Fax

Practice location:
  • Phone: 870-598-2546
  • Fax:
Mailing address:
  • Phone: 870-634-6428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberL43017
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: