Healthcare Provider Details

I. General information

NPI: 1659345247
Provider Name (Legal Business Name): STACI L HOPPER A.P.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STACI L WATSON APN

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 08/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2708 RIFE MEDICAL LN STE 200
ROGERS AR
72758-1452
US

IV. Provider business mailing address

2708 RIFE MEDICAL LN STE 200
ROGERS AR
72758-1452
US

V. Phone/Fax

Practice location:
  • Phone: 479-338-3080
  • Fax: 479-338-3089
Mailing address:
  • Phone: 479-338-3080
  • Fax: 479-338-3089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA01765
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: