Healthcare Provider Details

I. General information

NPI: 1346679388
Provider Name (Legal Business Name): STEPHANIE PATYK D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2013
Last Update Date: 09/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1609 N MEDICAL DRIVE
STUTTGART AR
72160
US

IV. Provider business mailing address

1609 N MEDICAL DR
STUTTGART AR
72160-3274
US

V. Phone/Fax

Practice location:
  • Phone: 870-674-6117
  • Fax: 870-672-6376
Mailing address:
  • Phone: 870-674-6117
  • Fax: 870-672-6823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE9812
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: