=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093218042
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | STACY L NORTH-FLANAGAN APRN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/15/2018
-----------------------------------------------------
Last Update Date | 08/17/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1420 S I ST
-----------------------------------------------------
City | FORT SMITH
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-784-0990
-----------------------------------------------------
Fax | 479-784-0948
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1200 FORT ST
-----------------------------------------------------
City | BARLING
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72923-2013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-782-0244
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LG0600X
-----------------------------------------------------
Taxonomy Name | Gerontology Nurse Practitioner
-----------------------------------------------------
License Number | A005574
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | A005574
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------