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General NPI Number Information
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NPI Number | 1740322122
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Entity Type | Individual
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Provider Name | STEPHANIE CHERRY PROCK AUDOLOGIST
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Gender | Female
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 05/05/2016
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Provider Practice Location Address
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Address Line | 4300 W 7TH ST
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City | LITTLE ROCK
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State | AR
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Zip | 72205-5446
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Country | US
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Telephone | 501-257-5250
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Fax |
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Provider Business Mailing Address
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Address Line | 3115 E KIEHL AVE STE B
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City | SHERWOOD
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State | AR
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Zip | 72120-3229
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Country | US
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Telephone | 501-833-8800
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Fax | 501-833-8803
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | A218
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License Number State | AR
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