Healthcare Provider Details

I. General information

NPI: 1083831069
Provider Name (Legal Business Name): CAROLYN ELIZABETH STEVENS A.P.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETH STEVENS A.P.N.

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 02/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N 7TH ST
WEST MEMPHIS AR
72301-2001
US

IV. Provider business mailing address

228 CABRIOLET ST
MARION AR
72364-2516
US

V. Phone/Fax

Practice location:
  • Phone: 870-735-4334
  • Fax: 870-735-1393
Mailing address:
  • Phone: 901-485-4156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberR31912
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA01672 ANP
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberP00843
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: