Healthcare Provider Details

I. General information

NPI: 1225567043
Provider Name (Legal Business Name): STEPHANIE GRYNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2017
Last Update Date: 06/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2560 OLD COUNTY RD
POCAHONTAS AR
72455-4118
US

IV. Provider business mailing address

2707 BROWNS LN
JONESBORO AR
72401-7213
US

V. Phone/Fax

Practice location:
  • Phone: 870-892-7111
  • Fax: 870-892-0930
Mailing address:
  • Phone: 870-972-4939
  • Fax: 870-972-4911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: