=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780557603
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NATHAN TYLER STONE CIT, RDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2025
-----------------------------------------------------
Last Update Date | 09/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2810 W WALNUT ST STE C
-----------------------------------------------------
City | ROGERS
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72756-0318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-256-8688
-----------------------------------------------------
Fax | 479-770-5137
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3942 E MONITOR RD
-----------------------------------------------------
City | SPRINGDALE
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72764-2602
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-256-8688
-----------------------------------------------------
Fax | 479-770-5137
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------