Healthcare Provider Details

I. General information

NPI: 1912838947
Provider Name (Legal Business Name): EVERWELL COLLECTIVE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 LISA LN
VAN BUREN AR
72956-2749
US

IV. Provider business mailing address

1203 LISA LN
VAN BUREN AR
72956-2749
US

V. Phone/Fax

Practice location:
  • Phone: 479-653-0493
  • Fax: 479-653-0493
Mailing address:
  • Phone: 479-653-0493
  • Fax: 479-653-0493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE MARCOM
Title or Position: FAMILY NURSE PRACTITIONER
Credential: MSN, APRN, FNP-C
Phone: 479-653-0493