Healthcare Provider Details

I. General information

NPI: 1750204699
Provider Name (Legal Business Name): STEPHANIE COTTLE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 JEFFERSON AVE
TEXARKANA AR
71854-4522
US

IV. Provider business mailing address

263 SEWELL DR
TEXARKANA AR
71854-0395
US

V. Phone/Fax

Practice location:
  • Phone: 870-774-7641
  • Fax: 870-774-1461
Mailing address:
  • Phone: 870-774-7641
  • Fax: 870-774-1461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberR048623
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: