Healthcare Provider Details

I. General information

NPI: 1356884647
Provider Name (Legal Business Name): STEPHANIE HULETT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2016
Last Update Date: 06/10/2022
Certification Date: 06/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2108 S 54TH ST
ROGERS AR
72758-8169
US

IV. Provider business mailing address

2570 W VANIKE DR
FAYETTEVILLE AR
72704-7549
US

V. Phone/Fax

Practice location:
  • Phone: 479-396-5200
  • Fax: 833-963-1060
Mailing address:
  • Phone: 479-396-5200
  • Fax: 479-464-9949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberA004868
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA004868
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: