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General NPI Number Information
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NPI Number | 1114524147
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Entity Type | Organization
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Legal Business Name | INDEPENDENCE ANESTHESIA LLC
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Dates
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Enumeration Date | 10/02/2020
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Last Update Date | 03/07/2022
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Provider Practice Location Address
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Address Line | 1710 MAYFIELD DR
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City | JONESBORO
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State | AR
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Zip | 72401-4563
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Country | US
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Telephone | 870-613-8390
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3283
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City | BATESVILLE
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State | AR
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Zip | 72503-3283
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Country | US
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Telephone | 870-613-8390
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STEVEN STALKER
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Credential | NP
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Telephone | 870-613-8390
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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